Preamble

The House met at half-past Two o'clock

PRAYERS

[MR. SPEAKER in the Chair]

PRIVATE BUSINESS

BRITISH RAILWAYS (LONDON) BILL [Lords] (By Order)

Order for Second Reading read.

To he Read a Second time on Thursday.

Oral Answers to Questions — Wales

District Health Authorities (Capital Allocations)

Mr. Raffan: To ask the Secretary pf state for Wales if he will make it his policy for the capital allocations to district health authorities to be assessed separately from the regional requirements of the total capital allocation.

The Parliamentary Under-Secretary of State for Wales (Mr. Ian Grist): It is already my policy to do so.

Mr. Raffan: As my hon. Friend is aware, under the regional review of December 1986 the capital resource assumptions for Clwyd health authority were reduced by approximately £10 million over 10 years. Does he agree that investment in the capital programmes of health authorities such as Clwyd — particularly increased investment—would enable them greatly to increase the efficiency and effectiveness of their hospitals, thus enabling them to provide a better service at less cost? Will he therefore make more money, not less, available to Clwyd so that schemes such as that for a Hollywell community hospital can be brought forward?

Mr. Grist: To some extent, my hon. Friend makes an obvious point. The other point is that health authorities should try to use their allocations as effectively as possible. I notice that in the current year Clwyd's capital allocation rose by 14 per cent. That is the sort of funding that enables the authority to give good service to its people.

Mr. Wigley: Does the hon. Gentleman accept that hospital closures are scheduled in Gwynedd such as those in Porthmedog and Llangefni—where new capital programmes had been promised but are not going ahead, yet the closures that were to make way for the capital programme are taking place? Is not that ridiculous, and cannot more capital be found to ensure that new hospitals are built instead of others being closed?

Mr. Grist: As the hon. Gentleman knows, I cannot comment on the proposals that will be coming forward from the health authority, because of the quasi-judicial


position of my right hon. Friend. Over recent years Gwynedd health authority has been the best funded, both in capital and current terms.

Sir Anthony Meyer: Is my hon. Friend aware that adequate capital allocation will enable money-saving schemes, such as the concentration of services at Glan Clwyd hospital, to take place, whereas under Labour there were savage cuts in the capital allocations, which probably resulted in increased expenditure on current account?

Mr. Grist: Indeed, that is what the right hon. Member for Swansea, West (Mr. Williams) said. He is one of the few who remember that. I certainly remember the fall in expenditure. In one year alone, real expenditure on capital on the Health Service in Wales fell by 33 per cent.

Mr. Roy Hughes: Does the hon. Gentleman recognise, too, that there are individual black spots, such as the Royal Gwent hospital at Newport, which has a massive waiting list that includes one of my constituents, Mr. Mark Williams of Rogiet? He is 77 years of age and has been waiting for the past 12 months for an operation on both his knees. Now he has been told that he must wait for a further 21 months. Yet at the same time the Minister goes around the country saying that by next April people will not have to wait longer than 12 months to get into hospital. Why does he go around making those false claims?

Mr. Grist: It is worth pointing out that the Gwent health authority has been funded since 1984–85 for capital by an increase of 145 per cent. It is up to the authority how it operates its finances. For instance, I hope the hon. Gentleman will agree that there are many ways in which it could raise funds, but it has so far obdurately refused to to so.

Hospitals and Health Services

Mr. Michael: To ask the Secretary of State for Wales whether he will make it his policy that no final decision will be made on future hospital and health service provision in South Glamorgan and other Welsh health authority areas, pending the outcome of the consultative processes currently in progress; and if he will make a statement.

Mr. Grist: It is already the policy of my right hon. Friend not to make a final decision on proposals for future Health Service provision that are referred to him until the relevant consultation process is complete.

Mr. Michael: The Minister will be aware of the excellence of the Royal Hamadryad hospital in my constituency, and of the fact that it appears on the consultative document very close to the beginning of the 10-year period, as does the children's ENT hospital in the constituency of my hon. Friend the Member for Cardiff, West (Mr. Morgan). Will the hon. Gentleman confirm that the position of those hospitals will not be prejudiced and that no decisions in line with the policy that he has outlined will be taken until the consultative process is over? Will he reassure people who are worried that it comes so close to the beginning of the consultative process that that is the case?
Will the hon. Gentleman also confirm that no decision has been taken about the district hospital in the docks area which at the moment is blighting the only area of factory land available in the city?

Mr. Grist: I can certainly confirm that no decision will be taken until the conclusion of the consultative process. That is what I have said before. I note what the hon. Gentleman said about hospitals in his constituency and in other constituencies.

Sir Raymond Gower: Will my hon. Friend take account of the fact that the Sully hospital building is among the best hospital buildings in the South Glamorgan area? Apparently the health authority has no further use for that hospital in the National Health Service. Will he look closely at this matter, because this is a splendid building which is admirably sited and has plenty of land? Surely it is highly desirable.

Mr. Grist: I can only repeat to my hon. Friend exactly what I have said up to this point, but I can add that his support over many years for Sully hospital has been widely noted.

Mr. Livsey: With regard to Health Service provision, will the Minister seek to ease the financial situation facing low-paid ancillary workers in the National Health Service? Will he also look at the financial position of medical laboratory scientific officers, who are making a substantial contribution to the well-being of the National Health Service? In my constituency some Health Service ancillary workers are paid £60 a week. That is less than half the £135 per week that is the European Community poverty level wage.

Mr. Grist: I note what the hon. Gentleman has said. These matters are generally decided at national level. Some people might wish that it were otherwise, but that is the position and all that I can do is to take note of what the hon. Gentleman says has said.

Mr. Nicholas Bennett: Can my hon. Friend confirm that as part of the consultation procedures he will discuss with the health authorities in Wales the present poor record of putting services out to tender, compared with the position in the English regions?

Mr. Grist: I certainly agree with my hon. Friend. We are looking for a greatly improved procedure in the coming year and we have been promised that by health authority chairmen.

Mr. Alan Williams: Has the Minister seen the representations made today to the Government by the three royal colleges of medicine that acute hospital services have almost reached breaking point? Is he also aware of an article in the British Medical Journal of 21 November by Russell Hopkin, the unit general manager at University hospital, Cardiff, saying that we face a similar crisis in Wales? In this context of an impending breakdown crisis, is it not incredible that there is a standing Welsh Office instruction to Welsh health authorities to try to save an extra 0·5 per cent. every year on spending in this very area of acute services?

Mr. Grist: It takes the biscuit to have the right hon. Gentleman lecture us. He was a Minister in the Government who saw spending on hospitals fall.

Hon. Members: Answer the question.

Mr. Speaker: Order.

Mr. Grist: The right hon. Gentleman saw pay cut by over 20 per cent., and saw the pay of consultants cut.


When he left government he left the Health Service in uproar, and that is why we have been in government for the last nine years.

Redundancies

Mr. Coleman: To ask the Secretary of State for Wales how many redundancies have been notified to his Department, to take place in (a) Neath, (b) west Glamorgan and (c) Wales during the last four weeks.

The Secretary of State for Wales (Mr. Peter Walker): The numbers of confirmed redundancies in Neath, west Glamorgan, and Wales during the calendar month of October — the latest available — were 32, 74 and 239 respectively.

Mr. Coleman: Does that answer not show that the euphoria of Conservative Members is somewhat premature? Are not the redundancies that are taking place full-time jobs, whereas any gains that we hear about are part-time jobs? Can the right hon. Gentleman tell us whether the redundancies that are taking place will appear in the unemployment statistics or will they disappear as a result of the Government's sleight of hand in these matters?

Mr. Walker: I know of the hon. Gentleman's interest in these matters and I am delighted to inform him that redundancies in Wales for the first nine months of this year were the lowest for many years. They were two thirds down on last year, and massively down on 1977, 1978 and 1979.

Water Quality

Mr. Win Griffiths: To ask the Secretary of State for Wales when he expects the two European Economic Community directives on water quality to be complied with in full in Wales, including the ending of all derogations currently granted by the Commission.

Mr. Grist: In respect of directive 80/778/EEC on water for human consumption, the Welsh water authority has in hand a programme of remedial works. As a result, the need for the 17 derogations and 22 delays, advised to the Commission under articles 9 and 20 respectively, should be removed by 1992 at the latest. In respect of directive 76/160/EEC on quality of bathing waters, the Welsh water authority programme of remedial works is scheduled for completion in the next 15 years, as I indicated in my answer to the hon. Gentleman on 26 October.

Mr. Griffiths: Will the Minister comment on the article that appeared in The Observer yesterday saying that there was to be a crash programme on the quality of drinking water, and will he say how that will affect the current programme of the Welsh water authority? Secondly, will he comment on the answer given to an oral question that I asked in the European Parliament last month, a copy of which I gave him today, which said that the Commission was concerned about the poor quality of bathing water in the United Kingdom, that it was pursuing a number of cases in the European Court of Justice against the British Government, and that it would not be satisfied with a 15-year delay? That being so, it is likely that the investment programme will have to be speeded up considerably.

Mr. Grist: I note what the hon. Gentleman said about the answer that he was given in Europe, which he very

kindly gave me at the start of Question Time. I cannot comment on it, except to say that the Welsh water authority is aware of the position. The programme on drinking water is, as I said, very well advanced.

Mr. Ray Powell: Is the Minister aware that we are all concerned about the quality of water? Did he listen to Radio One today to hear about the pollution of the Llynfi and Ogmore rivers in my constituency, where many salmon, sewin and trout have been washed up on to the banks of the river and children are picking up the fish and taking them home? What will the Minister do to ensure that everyone in my constituency and in other areas such as Bridgend and Porthcawl are informed that there is pollution in the Rivers Llynfi and Ogmore, going down to the sea at Porthcawl? What action will he take to ensure that this does not happen again?

Mr. Grist: This is an extremely serious matter, and I am not surprised that the hon. Gentleman has raised it. My officials are in contact with the Welsh water authority, which is responsible for doing exactly what the hon. Gentleman requires. The message about the pollution was flashed up on television stations last night immediately the position was known.

Sir Raymond Gower: When my hon. Friend looks at the matter, will he consider the fact that, whereas the European Commission appeared rightly to have given a good deal of emphasis to the effects of sewage deposits in the sea, possibly not enough emphasis was put on the massive pollution caused by great rivers such as the Rhine, which deposits much refuse in the North sea?

Mr. Grist: My hon. Friend may be right, but that does not come within the remit of the Welsh Office.

Mr. Wigley: Does the Minister accept that if the Government take tourism seriously they must do more to clean up beaches in Wales? The present position is absolutely disgraceful. How does the hon. Gentleman see privatisation having any beneficial effect?

Mr. Grist: The hon. Gentleman should be aware that it is proposed to spend £200 million within 15 years, and some £70 million will be spent on the 47 original waters listed; so a great deal of money will be expended on the cause he espouses.

Mr. Forth: Has my hon. Friend the Minister made any estimate, or told the water-consuming public, of the potential cost of these measures? Is he satisfied that the measures are realistic and reasonable? Has he satisfied himself, following the question by my hon. Friend the Member for Vale of Glamorgan (Sir R. Gower), about how far other members of the Community will take equal or more rapid steps towards meeting the same standards?

Mr. Grist: I am not in a position to answer that rather wide-ranging supplementary question. We endeavour to make people aware of the costs of works done on their behalf, not least through Question Time.

British Coal

Mrs. Clwyd: To ask the Secretary of State for Wales when he last met the chairman of British Coal; and what matters he discussed.

Mr. Peter Walker: I have spoken recently to the deputy chairman of British Coal and the director of the south Wales coalfield on a range of matters affecting the coal industry in Wales.

Mrs. Clwyd: What measures does the Secretary of State intend to take to protect south Wales pits and the supplies from them to the Central Electricity Generating Board and British Steel markets in the event of both organisations being privatised?

Mr. Walker: The announcement of the privatisation of British Steel is good news for the coal industry in Wales. There is no doubt that the two steelworks in question in south Wales are the strongest and most modern in the region, and with all the advantages of commercial freedom in future they are the most likely to be the beneficiaries of substantial investment. I think that this is good news for the coal industry. It will be good news if the negotiations on six-day production succeed and there is investment at Margam.

Mr. Barry Jones: Is the Secretary of State aware of the proposals by the Opencast Executive in my constituency that are creating disquiet and unease among residents, especially those at Cheapside, Liverpool road? Will the right hon. Gentleman or another Welsh Office Minister visit the area to meet the residents and hear their worries? Does the right hon. Gentleman know that good agricultural land is at risk and that residents fear for nearby amenities?

Mr. Walker: In former capacities I have become well aware that there is anxiety wherever opencast mining takes place. It must be recognised that opencast mining is an important part of the Welsh coal industry as a whole and makes an exceedingly important contribution to its success.

Mr. Raffan: Will my right hon. Friend take this opportunity to congratulate British Coal on the new £50 million surface drift mine at Point of Ayr in my constituency, which will enable output to increase by 30 per cent. to 600,000 tonnes a year? In only five weeks the new mine has resulted in an increase in output per man shift from 2·8 tonnes to 3·8 tonnes.

Mr. Walker: Yes. There are many other examples of substantially increased productivity. Hon. Members on both sides of the House should reflect that since March 1985, £100 million has been invested in the Welsh coal industry.

Unemployment

Dr. Marek: To ask the Secretary of State for Wales if he has carried out any research into the effects of unemployment upon the health of the people of the Principality.

Mr. Grist: No, Sir.

Dr. Marek: Is the Minister aware that many in the Principality believe that he and his Government bear a direct and heavy responsibility for increased ill health as a result of unemployment and the increased number of suicides during the years that the Conservative Administration have been in power? Does the Minister recall that Mr. Mark Robinson, who occupied his position prior to the 1987 general election, said on 20 January 1986

that he did not believe that there was any link between unemployment and ill health? Does the Minister agree with that?

Mr. Grist: There is no known causal connection between the two. Figures show quite clearly, however, that in the area of our society that is most prone to unemployment—socio-economic group five—there is the heaviest toll of ill health. That applies, however, whether individuals are employed or not. There is a serious problem in making the connection that the hon. Gentleman seeks to make. The aim and drift of our policies—for example, the valleys initiative, the reform of primary health care and the community nursing review—are directed at trying to correct the imbalance which we inherited, and which has existed for a long time in health services in some of the more deprived areas of Wales.

Mr. Butler: Has life expectancy increased since 1979 in Wales?

Mr. Grist: We certainly have many more old people. I must admit that my hon. Friend has taken me by surprise statistically.

Mr. Roy Hughes: The relationship may be difficult to assess, but will the Minister consider the position at Merthyr Tydfil, for example, where one in five of the population have been in hospital during the past three months? There have been 7,000 admissions over the past year and 10,000 people have been treated as out-patients. Only 10 days ago Hoover advertised 16 temporary vacancies and 150 queued overnight in the street for application forms. Does that not illustrate a catalogue of neglect on the part of the Government?

Mr. Grist: The very fact that Hoover has survived and prospered shows quite the reverse. The quality of the health services available to the people of Merthyr, including the Prince Charles hospital and all its facilities — the hon. Member for Merthyr Tydfil and Rhymney (Mr. Rowlands) knows that I visited it the other day and saw for myself that it is a marvellous hospital—shows how much we care for Merthyr and other parts of south Wales.

Common Agricultural Policy

Dr. Thomas: To ask the Secretary of State for Wales what representations he has received concerning the effects of proposed changes in the European Community common agricultural policy on Welsh farmers; and if he will make a statement.

Mr. Peter Walker: I have received numerous representations from all parts of the industry in Wales about the proposed reforms of the common agricultural policy. These have centred on the milk and sheep sectors. Negotiations are continuing.

Dr. Thomas: Will the Secretary of State now take advantage of my question to tell the House that he will defend the level of income for the sheep sector in Wales? Can he assure us that, as a result of sheep stabilisers or long-term changes in the variable or basic premium, there will be no drop in the income of sheep farmers?

Mr. Walker: I agree that in some low-income forms of agriculture—hill sheep farming and beef are examples—incomes must be maintained by one method or another.

Mr. Ron Davies: Will the Secretary of State confirm that, now that the guide prices have been announced for 1988, the sheepmeat regime will continue during that year? Will he also recognise that if the stabilisers which may or may not come out of the European Community put pressure on the lowland arable farmers and encourage them to move into sheep farming, that may have disastrous economic and social consequences for the Welsh uplands? What action will the right hon. Gentleman take to protect our upland communities?

Mr. Walker: My right hon. Friend the Minister of Agriculture, Fisheries and Food is in negotiations at present, in which he has made it very clear that he is interested, not in maintaining the sheepmeat regime just for next year, but in maintaining the principles of the regime continuously. It would be crazy for the Government to start contemplating what would be done if we were not successful in the negotiations. Our object is to be successful.

Japan (Ministerial Visit)

Mr. Gwilym Jones: To ask the Secretary of State for Wales if he will make a statement on the anticipated outcome of his visit to Japan.

Mr. Peter Walker: I met leading industrialists, bankers and politicians in order to establish with them the attractiveness of Wales as the location for Japanese outward investment into western Europe.
I am pleased that in the last month three further Japanese companies have decided to locate their industries in the Principality.

Mr. Jones: May I suggest to my right hon. Friend that the new factories and jobs that were decided on during his visit were a very worthwhile, positive contribution to the future of Wales, as was all the effort put into securing further investment, which I am sure will come? Was that not infinitely superior to the sterile arguments that my right hon. Friend would have had to listen to from the Opposition Benches if he had cancelled his visit?

Mr. Walker: Yes. I am almost tempted to ask you, Mr. Speaker, to extend our Question Time a little.
The total figures for Japanese interests in Wales are very impressive. I am delighted to say that among the people whom I met there were some who had originally invested heavily in Wales, and that most of them are deciding to increase their investments massively over the years ahead. I also managed to speak to some 200 or 250 leading Japanese industrialists who have an interest in the longer term in considering Wales as their location in western Europe. As I have always said, I believe that our success is due to the combination of the trade unions, local authorities and the Welsh Office having done everything possible to encourage Japanese firms.

Mr. Anderson: The Secretary of State will know that it has been quite difficult to attract Japanese firms to locate further west than Bridgend. Has he given any thought to the problem?

Mr. Walker: We are trying to attract Japanese firms to all parts of the Principality by the way in which we pursue our policies—through the Welsh Development Agency, with factory allocations, and by pointing out the various services that are available.

Mr. Morgan: Does the Secretary of State agree that it is extremely difficult to establish a causal link between his visits to Japan and the arrival of factories? One of the three Japanese investments was announced before he went to Japan.

Mr. Walker: As the hon. Gentleman knows, I was delighted to point out that that investment had been announced just before my visit. I joined others on the Friday before the visit in saying how pleased I was that it was happening. I hope that the hon. Gentleman will rejoice equally strongly over all the investment that will come from firms in the future, and that he will congratulate the Government on pursuing policies that will encourage them.

Health Care

Mr. Flynn: To ask the Secretary of State for Wales what plans he has to avoid a deterioration in health care in Wales arising from the financial difficulties faced by many Welsh health authorities.

Mr. Grist: District health authorities have management responsibility for ensuring the effectiveness of health care within the resources available to them. They have been funded well in excess of inflation. Between 1978–79 and 1987–88 their recurrent revenue provision grew by 32 per cent. in real terms.

Mr. Flynn: The Minister is again missing out the fact that, in order to stand still, health authorities need to be funded way above the rate of inflation to cope with the demands of our aging population and the more expensive needs of the medical services. The announcement that was made last week in a parliamentary answer shows that the funding is below that level. It copes with inflation, but it does not cope with the other needs. It is not the helping hand that health authorities need. It is another slap in the face and a certain prescription for a deepening crisis within the National Health Service. Will the Minister now admit that his Government's policy is to allow the NHS to decay and to allow services to become debased in order to force people into the private sector.

Mr. Grist: I do not think that the hon. Gentleman can have listened to the answer to the question, which showed that funding is well ahead of inflation. That is very different from the position before the hon. Gentleman came to this House. Under his party this country had to suffer. The hon. Gentleman referred to a reduction in Health Service funding. How can that service have been reduced when there are 13 per cent. more nursing staff, 13·3 per cent. more medical and dental staff, over 17 per cent. more consultants and over 10 per cent. more registrars? We are treating 84,000 more in-patients a year than were treated when the hon. Gentleman's party was in office. I cannot believe that that represents a failure in any service.

Mr. Foot: The hon. Gentleman's answers are based on largely phoney figures, going back over the whole period. Do they mean that he and his right hon. Friend will take no notice of the representations of the presidents of the royal colleges, whose most important representations were referred to by my right hon. Friend the Member for Swansea, West (Mr. Williams)? Surely the proper answer by anybody who represents, or is responsible for, the Welsh Health Service should be to say today, "We will


enter into immediate consultations with our British opposite numbers and ensure that something is done to meet the representations that are now coming not only from the Labour party but from the heads of the royal colleges and the great hospitals of our country."

Mr. Grist: When the right hon. Gentleman was a senior member of the Labour Government, the Health Service stumbled to its knees. Does he really call it a fake figure, when nurses' pay fell by over 21 per cent. when he was a Minister? Is that the way to run the National Health Service?

Mr. Gwilym Jones: My hon. Friend has tried to give the real facts about the increase in staff in the National Health Service, but the Opposition do not want to listen. Will he repeat those facts? Will he also tell me how many additional patients have been treated by the Health Service under this Government who would not have been treated had we returned to the funding levels that existed under the last Labour Government?

Mr. Grist: I shall repeat, because of the uproar last time, that the number of in-patients has increased by up to 84,000—an increase of 24 per cent. The number of out-patients has increased by 76,000. That is not a declining service; that is an improved service, as the people of Wales are well aware.

Health Services

Mr. Alan W. Williams: To ask the Secretary of State for Wales what proportion of health services in Wales are provided by (a) private medicine and (b) the National Health Service.

Mr. Grist: The information is not available in the precise form requested. However, there are in Wales 54 authorised pay beds in NHS hospitals and 212 beds in private hospitals; jointly these are equivalent to 1·23 per cent. of the NHS provision of 21,613 beds.

Mr. Williams: Will the Minister comment on Health Service developments in Carmarthen? It was announced in October that there was to be a private 50-bed hospital, costing £15 million—the first private hospital in Dyfed. The very next week the East Dyfed health authority announced that, because of financial constraints, it would have to shed 3 per cent. of its staff during the current financial year. Does that not reflect what is happening in our Health Service: that the Government are giving every encouragement and every incentive to private medicine but that the National Health Service is declining, by natural wastage?

Mr. Grist: The fact that somebody wants to open a private hospital in a particular area of the country does not say anything about National Health Service provision of health care. East Dyfed is receiving over £20 million for building the Llanelli hospital. There has been no lack of funds from central Government for the building of that hospital.

Mr. Williams: When Welsh health authorities are facing a serious financial crisis, when our hospitals fear a breakdown in services, when the Minister has already had to renege on his July commitment about hospital waiting lists, and when, on Friday, the Secretary of State issued a spending announcement showing that there are no plans even to meet fully the basic standstill needs of the Health

Service, which the Minister knows full well include not only 4½ per cent. for inflation but the 2 per cent. extra that is needed to meet the cost of the aging population and technological change, how on earth can the Welsh Office issue a press release such as that entitled "Additional Resources for Health and Personal Social Services", which is utterly smug, misleading, indifferent and inept?

Mr. Grist: That was a long, prepared supplementary question. I should like to give just one alternative figure. The right hon. Gentleman was a Minister in the previous Labour Government. When he left office, expenditure per family on the Health Service was £15·84 per week. It is now £21·14 per week. That shows the growth. The right hon. Gentleman was a senior Minister in a Government who cut spending and the pay of nurses and practitioners. That is a disgraceful record, but he has the cheek to come here and declaim against us.

Rating Reform

Mr. Rowlands: To ask the Secretary of State for Wales what assessment his Department has made of the average cost of the poll tax per family, as compared with rates bills, in local authorities in the valley areas of Mid Glamorgan.

Mr. Peter Walker: The average rate bill per household in Mid Glamorgan in the current year is £220. Future payments under the community charge will depend upon decisions to be made about grant and needs assessment levels, as well as the expenditure of the local authorities at the time.

Mr. Rowlands: Is it not a fact that, even by the most conservative estimates, the average tenant and homeowner in a community such as I represent will face a significant increase in the poll tax as compared with the rates bill? By what possible justification can there be equity or fairness in increasing the cost of services, rates or the poll tax to the people who are the poorer home-owners in the community?

Mr. Walker: In Wales less than 20 per cent. of all local Government expenditure will be met by the poll tax. Added to which, if the hon. Gentleman had listened to my answer to his question, the poll tax will depend on what happens about needs assessment levels.

Health Authorities

Mr. Nicholas Bennett: To ask the Secretary of State for Wales what representations he has received concerning staff shortages in Welsh health authorities; and if he will make a statement.

Mr. Grist: My right hon. Friend has received a number of representations about staff shortages in Welsh health authorities. This is an issue which is currently being addressed at both departmental and health authority levels.

Mr. Bennett: When my hon. Friend discusses this matter with the health authorities, will he bear in mind the problems of Pembrokeshire health authority and the fact that we are short of staff because of the wages that are paid? Does he agree that there may well be a case for bringing the market into the wages of staff in the Health Service and paying more in areas where it is difficult to recruit staff?

Mr. Grist: My hon. Friend may indeed have something in what he says. My right hon. Friend and I discussed the issue with the district health authority chairman on 23 November. My hon. Friend may be interested to know that last year the Department established a manpower steering group to develop a comprehensive manpower strategy for the National Health Service in Wales. The group is giving attention to recruitment difficulties and my Department has requested the district health authorities to prepare a 10-year manpower resources plan to forestall future difficulties.

Transport Links

Mr. Ieuan Wyn Jones: To ask the Secretary of State for Wales if he is satisfied with the standards of transport links between north and south Wales; and if he will make a statement.

The Minister of State, Welsh Office (Mr. Wyn Roberts): Recent years have seen a steady improvement in standards and more is being and will be done. A substantial number of schemes for improving the A470, A487 and A483 road links are either in progress or planned.

Mr. Jones: Does the Minister agree that one of the most important criteria in economic performance and development is good transport links? Does he also agree that there is an urgent need for a good, modern and efficient road linking north and south Wales? In view of the importance of roads in Wales to facilitate links with the Irish Republic and mainland Europe, will the Minister consider making an approach to the EEC for joint funding with the Irish Republic for road improvements in Wales?

Mr. Roberts: Naturally, we understand the importance of road links, which is why we have improved 128 miles of motorway trunk roads at a cost of £700 million since 1979. With regard to the north-south link, the hon. Gentleman must remember that certain improvements have been carried out. There is the Brecon bypass and the Dolgellau bypass, and the Abercynon-Pentrebach section has also been dualled. However, we must examine carefully the economic and traffic justification for any further work.

Pupils (Expenditure)

Mr. Knox: To ask the Secretary of State for Wales how much was spent per pupil in secondary schools in Wales in the most recent year for which figures are available; and what was the comparable figure for 1978–79, at constant prices.

Mr. Wyn Roberts: Provisional figures for 1986–87 show a unit cost figure of £1,320 for each secondary school pupil in Wales, compared with £1,033 in 1978–79 at constant prices.

Mr. Knox: Can my hon. Friend say whether capital allocations to schools in Wales have increased over the same period?

Mr. Roberts: I am happy to tell my hon. Friend that there has indeed been a substantial increase in capital allocations. The system was introduced in 1981–82 and from then to the current year there has been an increase of 50 per cent. The capital allocation for this year amounts

to £43 million, and for next year a capital allocation of £47·5 million has been announced by my right hon. Friend, which is a further increase of 9·1 per cent.

Oral Answers to Questions — CHURCH COMMISSIONERS

Clergy (Housing)

Mr. Harry Greenway: To ask the right hon. Member for Selby, as representing the Church Commissioners, what information he has as to how many beneficed clergy or priests in charge of parishes are currently housed (a) completely outside their parishes, (b) more than one mile from their churches and (c) in accommodation next door to a church in their charge; and if he will make a statement.

Mr. Michael Alison (Second Church Estates Commissioners, representing the Church Commissioners): The commissioners do not have the statistics, but their belief is that few incumbents live outside their parishes, and then only with the bishop's permission.

Mr. Greenway: Does my right hon. Friend agree that it is sad, wrong and damaging to their pastoral performance that some clergy now live outside the parishes for which they are responsible? Are not the Church Commissioners equally distanced from the feelings of many ordinary church people who do not wish to see in Crockford's, for which the Church Commissioner's are responsible—

Mr. Speaker: Order. Where clergy live is not relevant to that question.

Mr. Alison: I should tell my hon. Friend that there are about 9,000 parishes with parochial houses. I believe that all but a handful of parochial houses are located in extremely close proximity to the parish church in question. My hon. Friend also asked about the reference to the Archbishop of Canterbury in Crockford's, and if it is in order for me to respond—

Mr. Speaker: Order. I find it difficult to relate that to where the clergy live.

Clergy (Income)

Mr. John Marshall: To ask the right hon. Member for Selby, as representing the Church Commissioners, what information he has as to the proportion of clergy income currently provided through voluntary giving by the congregations; and if he will make a statement.

Mr. Alison: Forty-three per cent. of the total stipends bill for the Church's ministry is met from voluntary giving. I shall send my hon. Friend a copy of the Central Stipends Authority's 15th report giving further details.

Mr. Marshall: Does my right hon. Friend agree that the level of voluntary giving would be somewhat higher if so many churches had not thrown overboard the twin legacies of the Book of Common Prayer and the King James's Bible, and if certain parishes had given more of a moral lead on some of the great issues facing our country today?

Mr. Alison: I believe that a clear, moral and spiritual lead from both bishops and clergy is vital if Christian congregations are to be kept in good heart and their giving


is likewise to be kept in good shape. The fact that the contribution from parishes towards the stipend of clergy has doubled in the past decade is some sign that there is a good deal of good heart and proper leadership in many parishes.

Mr. Frank Field: While the right hon. Gentleman is correct to draw attention to the doubling of voluntary giving, is it not also important to use this opportunity to draw attention to the fact that if our clergy were dependent on our givings, we would be returning average salaries of less than £3,000 a year?

Mr. Alison: That is true. A substantial proportion of the stipend is met from the income of the Church Commissioners. It is also true that if the congregations were presented with a direct challenge of the need to make up what the Church Commissioners provide, they would rise to that challenge and the full sum would be forthcoming.

Rating Reform

Mr. Allen: To ask the right honourable Member for Selby, as representing the Church Commissioners, what further representations the commissioners have received from clergymen on the effects of poll tax on matters for which he is responsible.

Mr. Alison: The commissioners have received representations from clergy and church members about the serious financial implications of the proposed community charge for the clergy and the Church generally. The commissioners continue to work closely with the Churches main committee, which has approached Her Majesty's Government on behalf of the major denominations.

Mr. Allen: When will the right hon. Gentleman, who is speaking on behalf of the Churches, lead an open and public campaign on behalf of Christians, Jews, Hindus, and Muslims against the Government's poll tax, which affects synagogues, temples and churches without discrimination? When will he stop the Government allowing the imposition of VAT on religious works such as the Bible and the Koran? If the right hon. Gentleman refuses to answer me again this month, I will be back next month.

Mr. Alison: I shall welcome seeing the hon. Gentleman in his usual place. If he gives me regular notice of the question, it will not be difficult for me to answer. I should have corrected him by pointing out that no poll tax has been put on to the statute book, and no community charge has been levied by the Government against any denomination to which he referred. I reiterate my earlier answer, that the Church Commissioners are in correspondence and in contact with the Government about some relief for the churches in respect of the community charge corresponding to the 50 per cent. derating that they enjoy under the existing house rating provisions.

Oral Answers to Questions — PUBLIC ACCOUNTS COMMISSION

National Audit Office

Mr. Dalyell: To ask the Chairman of the Public Accounts Commission what criteria the commission uses in appointing an accounting officer for the National Audit Office under section 4 of the National Audit Act 1983.

Sir Peter Hordern (on behalf of the Public Accounts Commission): In appointing the serving Comptroller and Auditor General to be accounting officer for the National Audit Office Vote with effect from 1 January 1984, the commission followed the long-standing practice of appointing the officer in the best position to discharge overall responsibility for policy and for the resources allocated to the office. The Comptroller and Auditor General is, of course, by statute, head of the National Audit Office. I have no doubt that, following the appointment of a new Comptroller and Auditor General, the commission will wish to use the same criteria.
Perhaps the House will allow me to pay a tribute to the work of the outgoing comptroller and Auditor General, Sir Gordon Downey, who retires at the end of this month. The NAO and Parliament have been extremely will served by him.

Mr. Dalyell: I join the hon. Gentleman in paying tribute to Sir Gordon Downey. Does the Public Accounts Commission agree that whoever is his successor as Comptroller and Auditor General should tell Parliament to scrutinise the £1,000 million budget of the security and intelligence services?

Sir Peter Horden: That is not a matter for the Public Accounts Commission. The hon. Gentleman may, however, wish to pursue his inquiry with his right hon. Friend the Member for Ashton-under-Lyne (Mr. Sheldon), the Chairman of the Public Accounts Committee.

Mr. Allen: Will the hon. Gentleman make representations from the Public Accounts Commission to the Public Accounts Committee asking it to look into the possibility of surcharging the Leader of the House for the £750,000 which has been wasted prior to the setting-up of the Select Committees?

Sir Peter Hordern: That is not a matter for the Public Accounts Commission. I doubt whether it is a matter for the Public Accounts Committee.

Mr. Campbell-Savours: Is it not true that the accountability of the security services and the £1,000 million that they spend is not a matter that my right hon. Friend the Member for Ashton-under-Lyne (Mr. Sheldon) can deal with? Is it not a matter for the Government? Will the hon. Gentleman respond to the question from my hon. Friend? Will he, as Chairman of the Public Accounts Commission, make representations to Her Majesty's Government seeking the right for the Public Accounts Committee — or for a new security services scrutiny committee — to monitor, and indeed to audit, the accounts of the security services in this country?

Sir Peter Hordern: The role of the Public Accounts Commission is rather limited. Certainly it would not be our role to tell the Government what to do. However, the Comptroller and Auditor General has complete discretion in areas of Government activity which he may wish to examine and he may do so with the views of the Public Accounts Committee, which he should take into account.

Oral Answers to Questions — WALES

Ambulance Services (Gwent)

Mr. Murphy: To ask the Secretary of State for Wales what assessment he has made of the implications for


the effectiveness of Gwent's emergency ambulance services of implementing the reductions in crew numbers propssed in the report currently being considered by the health authority.

The Parliamentary Under-Secretary of State for Wales (Mr. Ian Grist): The management and operation of the ambulance service in Gwent is the responsibility of the Gwent health authiority and it is for the authority to determine the number of ambulance staff that it requires for the efficient operation of the service.

Mr. Murphy: Is the Minister aware of the considerable anxiety in the county of Gwent about this matter? Would not a reduction in crews be bound to affect the ambulance emergency services? Despite what he said, will he intervene if Gwent health authority decides to consider such a proposal?

Mr. Grist: I am aware of the proposals, but, given the Secretary of State's appellate functions, it would be inappropriate for me to comment on them now.

Oral Answers to Questions — HOUSE OF COMMONS

Select Committee Reports

Mr. Dalyell: To ask the Lord Privy Seal if he will make it his policy to ensure that all Select Committee reports are the subject of timely and substantive motions in the House.

The Lord Privy Seal and Leader of the House of Commons (Mr. John Wakeham): I refer the hon. Gentleman to the answer that I gave to the hon. Member for Nottingham, North (Mr. Allen) on 23 November. With regard to debating all Select Committee reports, I remind the hon. Gentleman that since 1979 there have been more than 500 reports from departmental Select Committees alone.

Mr. Dalyell: Should there not be a Select Committee to shadow the Department of the Attorney-General, which would give us an opportunity to have an informed debate, not only on the injunctions on the BBC, which should attract timely and informed parliamentary comment, but on the position of Mr. Charles Elwell? Is it not extremely unsatisfactory that a party committee, albeit the distinguished defence committee of the Conservative party, should invite a former security officer to Parliament? What does the right hon. Gentleman think about that?

Mr. Wakeham: The hon. Gentleman's latter point is not a matter for me, but I understand that the invitation is not being pursued. The other matters mentioned by the hon. Gentleman have been decided by the whole House, and I have no plans to make any changes.

Sir Hugh Rossi: Is my right hon. Friend aware that the Department of the Environment still has to reply to a report on "Historic Buildings and Ancient Monuments", published on 18 February last, a report on the "Property Services Agency" published on 8 April last, and a report on "Pollution of Rivers and Estuaries", published on 14 May last? We have been given various excuses, such as an impending general election and the non-reappointment of the Select Committee. Does my right hon. Friend regard those replies as satisfactory? Will he ensure that the convention that Command Papers are placed before the

House within three months of the publication of a report is adhered to in the future, and may we have a debate on those papers?

Mr. Wakeham: I shall certainly refer my hon. Friend's points to the Ministers concerned. Select Committees are entitled to replies to their reports, and in the majority of cases that has already been done. There is always pressure on time for debates, but I will do my best.

Mr. Beith: Does the Leader of the House have any plans to have discussions with the broadcasting authorities which deal with broadcasts from the House to ascertain what would happen if, during debates from Select Committees, including the Privileges Committee, references were made to people who had at some time been members of the security services?

Mr. Wakeham: From time to time I have discussions with broadcasting officials, and these matters may come up.

Mr. Rees: The Leader of the House will know that I am anxious that we should debate pretty soon the report of the Home Affairs Select Committee on Boundary Commission changes. The changes are already beginning for local government re-warding, and if we are not careful it will be too late to do something. It was an excellent report, and many hon. Members believe that the time has come to change the procedures of the Boundary Commission. But we can do nothing until we debate the report.

Mr. Wakeham: I know of the right hon. Gentleman's concern about such matters. I have already discussed the report with my right hon. Friend the Home Secretary, who will have a word with the right hon. Gentleman. As a result of those discussions, we shall decide how best to proceed.

Palace of Westminster (Cleaning)

Mr. Chapman: To ask the Lord Privy Seal if, pursuant to the answer of 16 November, Official Report, column 388, there are any plans to clean the stonework or otherwise improve the appearance of the internal courtyards of the Palace of Westminster.

Mr. Wakeham: Yes, the courtyards are included in the stonework restoration programme, but we intend to give a higher priority to the restoration of the south elevation and the Victoria tower.

Mr. Chapman: Although I welcome that answer and recognise that higher priority should be given to the Victoria tower and completing the clean-up of the external elevations of this splendid pile, does my right hon. Friend nevertheless agree that the general appearance of the internal courtyards is dirty and unsightly? If they were cleaned up, it would considerably brighten the environment of those using this Palace and also perhaps throw new light into some of the rooms and corridors.

Mr. Wakeham: I am glad that my hon. Friend agrees with our priorities for the stonework restoration programme. I accept that everything is not right with the courtyards. They are swept every day by the cleaning contractors. The Refreshment Department is responsible for taking its rubbish to the collection point in the State Officers Court. There are problems because of the


limitations imposed by the building, but I shall draw my hon. Friend's remarks to the attention of the Chairman of the Catering Sub-Committee.

Facsimile Transmission Equipment

Mr. Shersby: To ask the Lord Privy Seal if he will consider the provision at public expense of the necessary equipment to enable hon. Members to make facsimile transmissions from the House direct to other facsimile machine users for use in connection with their parliamentary duties.

Mr. Wakeham: Hon. Members are already able to make transmissions, on a repayment basis, from the facsimile machine in the Central Lobby post office. Several hon. Members have also purchased machines for their own use from their office costs allowance.

Mr. Shersby: Is my right hon. Friend aware that the provision of facsimile services to hon. Members at public expense would be no more revolutionary than the provision of telephone services to hon. Members some years ago? Is he further aware that the service available in the Central Lobby is the Intelpost service, for which hon. Members are charged £2·50 per page to receive a message and £3·50 to deliver the message from the machine in Central Lobby to an hon. Member in his office in the House? Does he not agree that that is most unsatisfactory?

Mr. Wakeham: The present arrangements appeared to be satisfactory until fairly recently. However, I recognise hon. Members' increasing interest in such facilities and I shall ask the Services Committee to consider this matter again.

Mr. Campbell-Savours: Is the Leader of the House aware that it is two and a half years since I asked the then Leader of the House to arrange for fascimile machines to be made available to hon. Members in various parts of the House? Is he aware that at that time it would probably have cost about £10,000 to do the whole House? Does he know that over the last one and a half years hundreds of thousands of pounds must have been spent by hon. Members on acquiring individual machines for their own offices, as indeed I did, and I spent £2,000 of taxpayers' money? Is it not a waste of money when a cheap route was available that would have been economic for the taxpayer and would have resolved the difficulties of hon. Members with offices in their constituencies hundreds of miles away?

Mr. Wakeham: The position up to now has seemed satisfactory to the majority of hon. Members. There is now an increasing demand and it is right that we should consider the matter again.

Mr. Tim Smith: Is it not something of a paradox that, when Government and Parliament are always lecturing people outside on the need to innovate and keep up with the latest technology, we always seem to be the last when it comes to introducing new technology for our own benefit? People outside cannot understand it when they are told that they simply cannot pass messages here and that messages must be sent by motor bike dispatch riders. If one does that, the messages promptly get lost in the system. These facilities must be introduced soon.

Mr. Wakeham: We have to work by consent. Hon. Members have different views about the speed at which technology should be introduced in this place.

Government Expenditure (Scrutiny)

Mr. Allen: To ask the Lord Privy Seal if he has any plans to bring forward proposals to enhance the scrutiny of Government expenditure by the House through departmental Select Committees and the Committee of Public Accounts; and if he will make a statement.

Mr. Wakeham: No, Sir.

Mr. Allen: I am sure that the Leader of the House is not aware that tonight the Government will try to sneak through public expenditure to the tune of £47 billion on the Vote on Accounts, and over £1 billion on the Winter Supplementary Estimates, without a vote, debate or reference to the Select Committees. Now that he is aware of that, will he ensure that this vast amount of public expenditure is at least debated by the House prior to the Consolidated Fund Bill?

Mr. Wakeham: I do not know about sneaking anything through. We are putting matters on the Order Paper in the proper fashion. It was not possible this year to have them debated by the Select Committees. For reasons which the hon. Gentleman knows, it was not possible to set up the Committees any earlier than was done.

Mr. Forth: Does my right hon. Friend think that it is time for a scrutiny of the expenditure by Select Committees, especially with regard to staff and travel? Does he believe that the House should now look again at the role of Select Committees and decide whether they are worth the money?

Mr. Wakeham: I agree that there are two points of view about Select Committees. Select Committees were established to provide expert and detailed scrutiny of departmental operations, complementing that of the PAC. They have discharged that role in a way in which the House would find difficult given other competing claims on its time. It is not necessary for their reports to be debated for them to have a significant effect on Departments and publicly.

Mr. Skinner: Is the Leader of the House aware that because the Select Committees were not set up in time at the beginning of the parliamentary Session a lot of money has been saved for the taxpayer in respect of all the trips that have not been enjoyed by hon. Members on both sides of the House—excluding a few of us who do not believe in this sloppy consensus system of Select Committees and who are aware that it does not produce any fruits for the taxpayer? Will he bear in mind that that money should be saved for the taxpayer? Does he agree that that money could be very usefully employed if it was sent to a country such as Ethiopia, where it could help to fill the starving bellies of the kids out there?

Mr. Wakeham: I thought that the hon. Gentleman was going to suggest that the money might be used to offset the surcharge that the hon. Member for Nottingham, North (Mr. Allen) sought to impose on me a minute ago. I recognise that, because the Select Committees were set up later than some people had hoped, money was saved. I do not put that forward as a valid argument. I believe that on the whole Select Committees do a good job for the House.

BBC (Injunction)

Mr. John Morris: I beg to ask leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,
the legal restrictions obtained by the Government on broadcasting by the BBC in the case of the radio series My Country, Right or Wrong.
The matter is specific in that it deals with the gagging of the BBC. Our Law Officers may be trigger-happy in seeking injunctions, but they are not anxious to explain themselves to the House. There was no statement from the Law Officers, and, but for my private question, the House, to which they are answerable, would not have heard from them. A debate will give them a proper opportunity to explain, and, more important, the opportunity to discover the Prime Minister's role in the matter.
The matter is important, as the injunction is but part of a process of limiting discussion. It is censorship. At any rate, at least the BBC was spared having its premises raided on this occasion.
The matter is urgent because it is obvious from the Attorney-General's letter to the BBC last Friday that there is an awareness in high places that the Law Officers" have gone too far and there is a willingness to compromise. The House wants to know what motivated the Attorney-General in trying to plug the dam against the charge of inconsistency or something substantial in the programme? Right hon. Members contributed to the programme. There is uncertainty about what the media may now report. Is it really the Government's considered view that allegations of illegal and subversive action must never be published without first informing the proper authorities?

Mr. Speaker: The right hon. and learned Gentleman asked leave to move the Adjournment of the House, under Standing Order No. 20, for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely,
the legal restrictions imposed by the Government on broadcasting by the BBC in the case of the radio series My Country, Right or Wrong.
I listened with care to what the right hon. and learned Gentleman said, but I regret that I do not consider that the matter he has raised meet the criteria laid down under Standing Order No. 20. I cannot, therefore, submit his application to the House. Perhaps I may tell the right hon.and learned Gentleman and the whole House that there will be opportunities to debate the matter — perhaps during the recess Adjournment debate tomorrow.

Parliamentary Questions

Mr. Alan Williams: On a point of order, Mr. Speaker. I promise that I shall not refer to the substance of any individual question. You will have noticed that out of 15 Welsh questions today, no fewer than seven related to health. You will also have gathered from the comments of my hon. Friend the Member for Merthyr Tydfil and Rhymney (Mr. Rowlands) and myself that on Friday the future policy for health in Wales was announced by written answer on a day when it is very difficult for hon. Members to know what is being announced.
You will have observed, Mr. Speaker, that the Secretary of State for Wales did not answer any of the seven questions that were tabled. Therefore, can you advise us, as Opposition and Back-Bench Members, how we can ensure that when an important policy statement is issued the Secretary of State answers at least some of the questions related to that statement instead of hiding behind a Parliamentary Under-Secretary of State, especially when that Parliamentary Under-Secretary of State does not seem to know the answers to any questions put to him?

Mr. Speaker: Who answers at Question Time is not a matter for the Chair, but I am sure that the representatives from the Welsh Office who may be on the Front Bench will have noted what has been said.

BBC (Injunction)

Mr Tony Banks: On a point of order, Mr. Speaker. Can you assure the House that any matter that is raised in the House in relation to the BBC's position regarding the injunction and the programme "My Country, Right or Wrong" can be reported by the BBC, because anything that is said here is, is of course, covered by parliamentary privilege? In fact, I understand that the terms of the injunction seem to be preventing the BBC from even reporting the proceedings of the House. Clearly that must a be serious infringement of our rights.

Mr. Speaker: Order. The hon. Member knows that anything that is mentioned in the House is in the public domain. It is a matter for the BBC whether it reports what is said.

Parliamentary Language

Mr. Tam Dalyell: On a point of order. Mr. Speaker. May I raise a matter of which I gave your office notice, namely, the use of language in the Chamber? It will be within your recollection that, a fortnight ago, I was expelled from the House for five days for having made an extremely specific accusation about the action of a parliamentary colleague in relation to a specific event—Westland. I did not use generalised abuse. It was a specific point at issue, and it will be within the recollection of the House.
May I draw your attention—the attention of your office has been drawn to it — to column 1124 of the previous Thursday's Hansard? It will be within your recollection, Mr. Speaker, that the hon. Member for Northampton, North (Mr. Marlow) used an extremely abusive word that was not withdrawn, namely, "twerp", in referring to my right hon. Friend—[Interruption.] I am sorry, but sauce for the goose is sauce for the gander.
If some of us are to be expelled for being wholly courteous when making a political charge, we want to know what the general rules are in this regard. I realise that you are in a difficult position, Mr. Speaker, and that there are times when you should turn the Nelson eye. However, the hon. Member for Northampton, North was, in a sense, far more generally abusive of the Leader of the Opposition than I was about the Prime Minister. I wonder whether you have any reflections on this matter?

Several Hon. Members: rose—

Mr. Speaker: Order. The hon. Member said that he intended to raise this matter, but I thought that he intended to do so last week. At the moment when, regrettably, I had to name the hon. Member, he had the Floor of the House and, in a calculated way, he used an un-parliamentary expression. I think that the hon. Member accepts that. I have to confess that I did not hear what happened on Thursday because there was a great deal of noise. The comment was made from a sedentary position, and it was not until I read Hansard on Friday morning that I saw exactly what had been said. I must say to the hon. Members for Linlithgow (Mr. Dalyell) and for Northampton, North (Mr. Marlow) that had I heard the remark at the time I would, of course, have had it withdrawn. But I did not hear it.

BBC (Injunction)

Mr. Merlyn Rees: On a point of order, Mr. Speaker. I seek your advice because, three or four weeks ago. I appeared on a BBC programme together with the former Lord Chancellor. Last week, much to my surprise, I learnt that the programme had been banned. I understand that the BBC is to oppose the injunction and that we might be in for a long legal case. Would I be in order, under the sub judice rule, if I repeated what I said on that programme, which has been banned, on the Floor of the House?

Mr. Speaker: If the right hon. Gentleman is called in the debate tomorrow, what he says in his speech will be entirely a matter for him. What we do not allow in the Chamber is the reading out of excerpts.

Mr. Frank Dobson: On a point of order, Mr. Speaker. I seek your guidance, following your earlier reply. You said, in answer to a point of order from my hon. Friend the Member for Newham, North-West (Mr. Banks) that should anything be said in the Chamber it would be in the public domain. Will you confirm that if it is in the public domain, if the BBC reports it, and if any action is taken by the Government following that reporting, you would regard that action by the Government as a gross contempt of this High Court of Parliament?

Mr. Speaker: I am not responsible for anything that the BBC may or may not say. The BBC will have to take the advice of its legal advisers and make up its own mind as to what it reports from this place. I repeat that everything in the High Court of Parliament is in the public domain.

Mr. John Morris: On a point of order, Mr. Speaker. This is a very important point and you, Mr. Speaker, with respect, are the guardian of the liberties of the House. Of course, anything that is said in the High Court of Parliament is privileged. What we want to ensure is that no one will be adversely affected if he reports anything that is said in the House, including, in particular, if he names anyone who is or has been in the security services. At present, the media, particularly the BBC, are inhibited from so doing, in accordance with the terms of the injunction. It would be a grave incursion into the liberties of the House if action were taken against anyone who reported the proceedings of the House in that way.

Mr. Speaker: That would not be a matter for me. I am responsible for order in the House and for what goes on here. I am not responsible for what the BBC does or does not put out on radio or television.

Mr. Max Madden: On a point of order, Mr. Speaker. As you know, I applied today, under Standing Order No. 20, for a debate on the injunction preventing the media from giving the public information about the activities of the security services. I heard your reply to the application made by my right hon. and learned Friend the Member for Aberavon (Mr. Morris). We are placed in some difficulty, because the Leader of the House replies to the debate on the motion to adjourn for Christmas, and on many occasions you have heard the Prime Minister refuse to add anything to the statements that she has made on these matters.
What lies at the heart of our concern is the alleged inconsistency of Government policy on the confidentiality of the security services. The difficulty is that we cannot have any debate unless you grant one in which the Prime Minister, who is responsible for Government policy in these matters, is required to answer to the House. I therefore ask you, Mr. Speaker, to reflect on that difficulty and indicate whether, on reflection, you believe that an application under Standing Order No. 20, such as has been made by my right hon. and learned Friend the Member for Aberavon or by me, would facilitate such discussion.
We believe that the accountability of the security services is of major public importance and that the House should be given an early and full opportunity to discuss that issue. We cannot obtain that debate unless you grant it. That is why there is urgency in this important matter.

Several Hon. Members: rose—

Mr. Speaker: Order. I well understand the concern of the House about this issue, but under the standing order I must have regard to other opportunities which the House may have to debate or discuss matters. I have already indicated to the House that there will be an opportunity tomorrow to raise the matter in the debate on the motion to adjourn for Christmas. As to who answers it, it is not my responsibility, but that is the immediate opportunity to discuss this issue.

Mr. John Morris: On a point of order, Mr. Speaker. I am sorry to trespass even further on your generosity, but I raise, I hope, a matter that comes within your specific responsibilities as the guardian of the liberties of the House.
My understanding is that the BBC has been given the privilege of broadcasting the proceedings of the House. In particular, it has been given certain facilities within the precincts of the House. I understand that the BBC is now enjoined by the injunction of another court that it should not report the names of persons who either are or have been in the security services; for example, the well-known author of the book "Spycatcher", Mr. Peter Wright. If that name were to be mentioned this afternoon — we have been mentioning it backwards or forwards for the past six or nine months—if the BBC were to use our facilities and report that through the machinery that it now has, and if an action for contempt were brought against the BBC by the Attorney-General, would not that be an inhibition of the rights granted to the BBC by the House?

Mr. Speaker: Order. It is a hypothetical matter — —[Interruption.] The right hon. and learned Gentleman said "if". Surely that is hypothetical.

Mr. Norman Buchan: Further to the point of order, Mr. Speaker. You referred to the matter being hypothetical, but there is no other means of defining action in the House except by postulating a situation. We are asking you, Mr. Speaker, to say that you will protect the rights of the House in so far as we have the right, under privilege, to have the proceedings of the House reported outside. That is not a hypothetical matter. It has affected us every day in the past and will affect us every day in the future. We want that assurance from you, Mr. Speaker.

Mr. Speaker: Order. Allow me to give that assurance. The hon. Gentleman and the whole House know that anything said in the House, provided it is in order, is the responsibility of the hon. Member concerned. The reporting of them outside is not a matter for me.

Several Hon. Members: rose—

Mr. Speaker: Order. I have dealt with the matter. I cannot say any more. I am not responsible for the actions that others take outside the House; I cannot possibly be.

Mr. Rhodri Morgan: Further to the point of order, Mr. Speaker. We entirely accept what you have just said, that you are in no way responsible for the editorial judgment of the media, whether or not it is the BBC, but surely you are responsible for seeing that that editorial judgment is not inhibited by the Government.

Mr. Dennis Skinner: Further to the point of order, M r. Speaker. As you will recall, many years ago the BBC was given the power and the right to record our proceedings, provided that it was done in a fair and responsible way. That meant that it should be at the

convenience of the House and that, as its head, Mr. Speaker would be in charge of monitoring in the event of the BBC's not carrying out proper and responsible reporting of the proceedings. I see you shaking your head, Mr. Speaker, but if you look at the record you will see that the BBC was given that power only on condition that it carried out fair, responsible and balanced reporting.
The truth, as we now know, is that the reporting is not balanced. We know that what the Attorney-General did last week means that the BBC cannot carry out the remit that it was granted, in about 1974–75, to broadcast Parliament. If the BBC is not carrying out that balanced reporting it seems to me that you, as Mr. Speaker, and all of us for that matter, must see to it, in some way, that that remit is carried out. Therefore, in my opinion, that in itself is a matter for you and for the House of Commons.
I suggest that on this issue it is important, and convenient, for the House to see to it that the BBC's reporting is at all times fair and balanced, and if there are discussions about the Attorney-General's injunction and they are reported in Parliament, that should be carried on the BBC air waves, because it would be fair and balanced reporting.

Mr. Speaker: Order. It is perfectly right, as the lion. Member for Bolsover (Mr. Skinner) has said, that it was laid down at the time that reports should be fair and balanced, and a Committee was established in the House to ensure that that occurred. It has never been the responsibility of the Speaker to decide which parts of our proceedings should be broadcast. Frequently I have been informed by the BBC that it intended to broadcast certain parts of our proceedings. It is not for me to tell the BBC what it should broadcast.

Mr. Dobson: Further to that point of order, Mr. Speaker. I have been following the wise words of my hon. Friend the Member for Bolsover (Mr. Skinner). Conservative Members appear to make light of a potential invasion of our liberties such as has not taken place in this century. They should, perhaps, remember that they have a duty to the people who elected them—and to those who did not—to sustain the liberties of the House and the freedom of the BBC to report what goes on here.
Having said that, I would be grateful if you, Mr. Speaker, would undertake further to consider the points that have been made and the application under Standing Order No. 20 by my right hon. and learned Friend the Member for Aberavon (Mr. Morris). In view of the points that have been made this afternoon, and of the deep concern that is felt by Opposition Members and, I suspect, by one or two of the quieter Members on the Conservative Benches, and certainly by the BBC, I hope that if there is no further development that is favourable to freedom of speech you will be prepared to consider favourably a further application under Standing Order No. 20.

Several Hon. Members: rose—

Mr. Speaker: Order. We have a busy day ahead of us. I undertake to reflect on what the hon. Member for Holborn and St. Pancras (Mr. Dobson) has said.

Mr. Andrew Faulds: rose —

Mr. Speaker: Order. Is it a different point of order?

Mr. Faulds: This is a specific point of order about this afternoon's proceedings.

Mr. Speaker: Order. I have already said that I shall reflect on the matter.

Housing (Scotland) Bill

Mr. John Home Robertson: On a different point of order, Mr. Speaker.

Mr. Andrew Faulds: In that case, sit down.

Mr. Speaker: Order. I decide who is called to speak.

Mr. Home Robertson: I think that my hon. Friend the Member for Warley, East (Mr. Faulds), wants your job, Mr. Speaker.
I want to refer you, Mr. Speaker, to the Housing (Scotland) Bill, which was published by the Government on Friday. It is an important measure that will dismantle the public sector housing service in Scotland. According to the index to the Bill, it has 67 clauses and 10 schedules. However, look as I might, I could find only nine schedules in my copy. The incompetence of the Scottish Office is legendary. It could not run a sweetie shop. I do not expect you to comment on that, Mr. Speaker, but can you please give an assurance that the House will not be required to consider on Second Reading a Bill that has not been properly published by the Government? Am I right in thinking that the Government will have to have it reprinted and allow a further two clear weeks—during the time that the House is sitting—before we consider the Bill on Second Reading?

Mr. Speaker: Order. I understand that there was some defective printing in the Bill and that it is being reprinted and will be re-issued tomorrow.

Urban Development Corporations

Mr. Roland Boyes: On a point of order, Mr. Speaker. The Secretary of State is now unveiling to the press his plans to create a number of new urban development corporations, and members of the press therefore have an opportunity to cross-examine him on these matters. Is it not a scandal that Members of Parliament are being denied the opportunity to question the Secretary of State when the creation of urban development corporations will directly affect the constituencies and constituents of hon. Members? Will you, Mr. Speaker, use your influence to enable us to hear the Secretary of State make an oral statement in the House —not an answer to a written question—on the creation of a whole series of new urban development corporations?

Mr. Simon Hughes: Further to that point of order, Mr. Speaker. In relation to the announcement mentioned by the hon. Member for Houghton and Washington (Mr. Boyes), an announcement is to be made either by a press release or by a written reply. As I recall, Mr. Speaker, you have said in the past that these matters should be announced to the House. I ask you to invite the Minister to do that in this case.
You will remember, Mr. Speaker, that only last week we had the Third Reading of the Urban Development Corporations (Financial Limits) Bill, which reduces the opportunity of the House to debate any matters to do with the activities and financing of urban development corporations. That annual and regular opportunity will be lost if that Bill becomes law later this Session. Given that this week we are to debate local authorities and to approve their orders and their financing, it is unacceptable that the Secretary of State should make an announcement outside the House about territory that is effectively being moved out of the control of local authorities and into the control of Government quangos appointed by Ministers. These quangos are entirely unaccountable and have been much criticised, especially recently, in connection with all sorts of dubious activities. No Minister came to the House to make an announcement about that handover. Can you, Mr. Speaker, make strong representations to ensure that we get a statement on this issue, if not today, tomorrow?

Mr. Speaker: The hon. Members for Southwark and Bermondsey (Mr. Hughes) and for Houghton and Washington (Mr. Boyes) have made strong representations and I am sure that they will have been heard by the Leader of the House.

Mr. Boyes: rose—

Mr. Speaker: Order. It is not a matter for me.

Mr. Boyes: It is a matter for the Leader of the House and, as he is present, I hope that he will tell us whether there will be a statement later today or tomorrow on this very important matter.

Housing (Scotland) Bill

Mr. John Home Robertson: Further to my earlier point of order, Mr. Speaker. I am grateful to you for telling us that the Bill is to be reprinted tomorrow.


Can you confirm that it would be quite improper for the House to be required to consider that on Second Reading next week as the Bill was not available to us in its proper form last week?

Mr. Speaker: As the hon. Gentleman knows, that again is not a matter for me. I do not decide when Bills are to be debated, but the hon. Gentleman's point will have been noted.

BBC (Injunction)

Mr. Andrew Faulds: rose—

Mr. Speaker: As it is nearly Christmas, I call Mr. Andrew Faulds.

Mr. Faulds: Your parliamentary charity and generosity. Sir, are well renowned.

Mr. Tony Banks: We can see him at Selfridge's as well this year.

Mr. Faulds: I hope that this young puppy is not referring to you, Sir. Mine is an immediate, practical point of order to do with the proceedings that the House indulged in a few moments ago.
As understand it, the practical result of the injunction obtained by the Attorney-General in the courts is that if the BBC wanted to broadcast the exchanges that took place it would have to introduce a bleep the moment the name of Mr. Peter Wright was mentioned. Is that really the practical result of this injunction? If that is so, is it not totally unacceptable censorship of the House of Commons?

Mr. Speaker: I am not an expert on injunctions, so I cannot answer the hon. Gentleman's question. However, I shall ensure that the rights and privileges of the House are upheld.

Mr. Jeremy Corbyn: On a point of order, Mr. Speaker.

Mr. Speaker: Is it a different point of order?

Mr. Corbyn: It is on this matter.

Mr. Speaker: I cannot help the hon. Gentleman, but I call him to put his point of order.

Mr. Corbyn: Thank you, Mr. Speaker. On Friday the whole nation heard on the BBC 6 o'clock news that the Corporation was unable to report part of what went on in Parliament because of the injunction that had been obtained against it. Therefore, I ask you to give a ruling on this question. If the BBC is prevented by an injunction from reporting part of what goes on in Parliament, it follows that that is an infringement of the rights of Parliament to discuss what it wishes. Surely it also calls into question Hansard and its distribution, because if the injunction covers what is said in Parliament, quite specifically the BBC, newspapers and other news media are prevented from reporting exactly what is said in Parliament.
You, Mr. Speaker, have the right to uphold the legal immunity of Parliament to disuss what it wishes, in the way that it wishes, and to uphold the right of the report of its proceedings to be freely available to every person in Britain. Quite clearly, in granting this injunction against the BBC last week the courts have infringed that right. We appeal to you to protect our right to speak freely in the House and, above all, to protect the rights of people outside Parliament to listen to what we discuss.

Mr. Speaker: I can only repeat what I have already said; that whether a broadcast is made is not a matter for me. I certainly uphold the right of hon. Members to have their say in this Chamber and their right to be reported in Hansard.

STATUTORY INSTRUMENTS &c.

Mr. Speaker: With the leave of the House, I shall put together the four motions relating to statutory instruments.

Ordered,
That the Farm Diversification Grant Scheme 1987 (S.I., 1987, No. 1949) be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the Agriculture Improvement (Amendment) Regulations 1987 (S.I., 1987, No. 1950) be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the Farm Business Specification Order 1987 (S.I., 1987, No. 1948) be referred to a Standing Committee on Statutory Instruments, &amp;c.
That the draft United Kingdom Central Council for Nursing, Midwifery and Health Visiting (Electoral Scheme) (Variation) Order 1988 be referred to a Standing Committee on Statutory Instruments, &amp;c.—[Mr. Darrell.]

Orders of the Day — Health and Medicines Bill

Order for Second Reading read.

Mr. Speaker: Before I call upon the Minister, in view of the rather late start to the Bill and the large number of right hon. Members and hon. Members who wish to participate, I appeal for short contributions.

4 pm

The Minister for Health (Mr. Tony Newton): I beg to move, That the Bill be now read a Second time.
On 25 November I announced publication of the Government's White Paper on primary health care, "Promoting Better Health". The White Paper set out the Government's strategy for primary health care and our key objectives. These were to make the services more responsive to the needs of the consumer, to promote health and prevent illness, to raise standards of care and to improve value for money.
The Bill, which was read the First time on the same day, paves the way for the implementation of some parts of that strategy, others of which do not require legislation. The Bill goes wider than primary health care, for example, in giving health authorities new powers to generate additional income for patient care in various ways. I shall comment on those provisions later.
First, I should like to say a word about the context of the primary health care provisions of the Bill, which I suspect are those on which much of the debate will focus. As the primary health care White Paper stated, expenditure on family practitioner services has risen by £1·5 billion, or 43 per cent. in real terms, since 1978–79 and our existing plans provide for additional expenditure by 1990–91 of over £0·5 billion more in real terms.
The proposals for promoting better health, taken together, will require sizeable additional resources. Subject to the progress and nature of negotiations with the professions, I expect expenditure on the family practitioner services by 1990–91 to be substantially in excess of £600 million in real terms more than it is today. It was against that background, as I emphasised in my statement on the White Paper, that we concluded that it was reasonable to secure some of the additional resources going into primary care services by asking those who can afford it to meet something more of the overall cost of their health care, with the provisions in the Bill concerning dental charges and eyesight tests, about which I shall have something to say at the appropriate part of my speech.

Mr. Eric Forth: I apologise to my hon. Friend for intervening so early, but will my hon. Friend consider looking more widely at our Health Service and consider the French approach, where people are asked to make a contribution whenever they consult the health services? This would broaden the principle he is outlining and upon which he will expand. Is he prepared to look at it on the same basis, because it might give us more resources and may have a wider beneficial effect than the measures he is proposing today?

Mr. Newton: I note my hon. Friend's suggestion. He will note that there is no proposal along those lines in the Bill. I would not wish to be drawn to comment on that today.
As the House knows, our principal aims, through those proposals, are to improve the standards of care, in particular in the inner cities, and to give greater emphasis to the prevention of ill health. We believe that more can be done for the family doctor service through the practice team by vaccination, immunisation and screening for cervical cancer. The White Paper outlined our plans in those areas for what might be called prevention targets. The intention is that doctors have targets for each of the main preventable diseases and the action taken to prevent them. We shall relate remuneration to the achievement of those targets and encourage greater provision of more general advice on keeping healthy, not only by doctors but by other members of the practice team. We shall introduce a sessional fee for health promotion sessions.
We emphasise also—it is an important point in the broader context of this debate—that vulnerable groups such as elderly people should be properly cared for. In recognition of those needs, higher capitation fees are paid already for each patient over 65 and 75. We propose to discuss with the profession what sorts of additional services should be provided for elderly patients. The routine screening of mobility, sight, emphysema and hearing, and keeping in touch by one means or another with elderly patients, particularly those who live alone, are the sorts of services we have in mind.
The effective development of this approach depends not only on the doctor but on a strong practice team. It is this which lies behind clause 13 of the Bill. We propose to release more funds to enable practice teams to take on extra skills and to carry out the sorts of task I have just described. That may mean, for example, additional practice nurses or the extension of services provided by a practice to include the care that can be given by people such as counsellors, physiotherapists or chiropodists. In inner-city areas, or other areas where a similar problem arises, some practices may wish to recruit interpreters under this heading to help people of ethnic minorities whose command of the English language is limited. Subject to negotiations with the profession, more money will be made available for those purposes.
We also intend to abolish the current central constraints on the type and number of team members whose salary costs can attract direct reimbursemment. Clause 13 substitutes a more flexible system, which rests on giving the local family practitioner committee or health board freedom to determine need and allocate priorities within a budget. Clause 12 will strengthen practice teams by clarifying and extending the scope for reimbursing the training costs of staff. For example, subject to the passage of the Bill, we intend to arrange for general practitioners to be reimbursed for the training costs of practice nurses and for financial recognition to be given to those general practitioners who provide clinical training for undergraduate medical students. Both changes, which have been widely welcomed by the profession, would help to improve the quality of primary care.

Mr. Dafydd Wigley: Welcome though it may be that physiotherapy, chiropody and other GP services will be extended, how will the Government ensure that minimum standards are retained and that we do not have a patchwork of standards which vary considerably from area to area, withour any guarantee being imposed on the GP services?

Mr. Newton: That is precisely why we think it right to move to the allocation of budgets to family practitioner committees and health boards, so that they can have a say in determining the priorities for expenditure in those areas and seek to achieve a better spread and balance of services than we have at the moment. This is something that sometimes affects rural areas, which may be what the hon. Member for Caernarfon (Mr. Wigley) has in mind. More often it affects inner cities and deprived areas, which have been the more common focus of attention.
The more flexible approach reflected in those clauses also affects clause 13, which provides for financial assistance for practice premises through improvement guarantees or under the cost rent scheme to be controlled locally under a cash-limited system. This picks up the hon. Gentleman's point; it enables locally set priorities to be determined and makes it easier to direct funds to the areas where they are needed most. Quite apart from practice team support, it is often the case that the premises of family doctors are at their worst in the inner city and other deprived areas, and we wish to direct extra resources to their improvement.
Family doctors can also be helped to buy surgery premises by obtaining Government-guaranteed loans from the General Practice Finance Corporation. The White Paper announced our intention to seek powers to change the constitution of the GPFC to allow maximum use of private sector funds. We propose that the corporation should become a statutory company under the Companies Act and a trust should be set up to represent the medical profession on the board of the new corporation. The exact shape of the new arrangements will depend on discussions with the corporation and with the general medical services committee of the British Medical Association, as well as with potential investors. Clauses 1 to 3 would provide powers to enable such changes to take place. They would provide also for the GPFC to have greater access to private sector funds in the period before reconstruction.
I have referred to premises in inner cities and to support for general practitioners in those areas. A striking feature of the inner cities is that they have an above average number of elderly doctors—some of them are very elderly— who too often practise on their own.
The responsibilities of family doctors are extremely exacting and we would expect them to become more exacting following the implementation of the proposals that I have outlined. We have come to the conclusion that it is not reasonable to expect doctors to continue to work beyond the age at which they can carry out their responsibilities properly under NHS contracts.
Clauses 5 and 6 are intended to change the present system. They would give powers to introduce a compulsory retirement age for general practitioners and would end the so-called 24-hours retirement, whereby doctors over the age of 65 years can retire, draw their pension and return to practice a day later without any reduction in either pay or pension. Our proposals were widely supported in consultation and by the Select Committee on Social Services. We would expect and hope that the places of retiring doctors would be taken by younger, vocationally trained doctors who are genuinely keen to work in group practices and as members of primary care teams. That we see as contributing to the improvement in the standard services that we wish to see.

Mr. Tam Dalyell: Dentists often own their own businesses, which means that compensation would have to be paid. Any rapid decision to make dentists sell would depress prices, and perhaps mean they would be treated unfairly.

Mr. Newton: The hon. Gentleman has raised a fair point. If he reads the White Paper he will see that it contains passages on compensation for goodwill. That is something that we have in mind and it will be considered in our negotiations with the professions.
I have referred to the £170 million overall that we expect our proposals in respect of dental charges and eyesight tests to contribute to the £600 million-plus of additional expenditure on primary care services that we expect over the next three years.
I shall turn directly to the issue of dental charges and to clause 8, which is concerned with them, because I know that this is a matter of some concern to the House. The House will know that we propose to move to a proportionate charge for dental treatment and to extend that system to dental examinations that are now free. Existing powers already permit proportionate charging for routine dental treatment. Clause 8 is required to enable such charging to cover dentures and bridges and to permit charges for dental examinations. It follows that we intend to move to the new arrangements in stages.
Under existing provisions, regulations will be brought before the House at the appropriate time to provide for proportionate charges from 1 April 1988. The regulations will also specify fixed charges for dentures and bridges at or about the same percentage of cost. Bearing in mind that the current average of the proportion of treatment charges that is met by the patient is 65 per cent. and that there has been no increase in dental charges since 1985—in other words, by next April they will have been unchanged for three years—we expect to set the figure at 75 per cent. At the same time, the maximum charge—I know that the British Dental Association has been concerned about this—will be increased from £115 to £150.
Subject to the passage of the Bill, we would at a later stage move the charges on bridges and dentures to the same fully proportionate system for routine treatment and introduce the proportionate charge for the dental examination. The House will be aware that the principle of moving to proportionate charges for treatment has been widely welcomed and pressed for by the profession. In saying that, I intend only to associate it with the principle, not with a particular rate.
I think that it is generally acknowledged that the present system is difficult for the public to understand, difficult for the profession to administer and difficult for anyone to defend as fair. For example, the present charges for dentures, bridges and crowns vary from 25 per cent. to 93 per cent. of the cost. The cost of routine treatment ranges from 100 per cent. to less than 50 per cent.
I wish to emphasise the need to consider our proposals as a whole. The move to proportional charges will reduce substantially the costs of much routine treatment. For example, on current figures a 75 per cent. charge would cut the cost of a clean, polish and two small fillings from £14·20 to £10·65. I acknowledge readily that that saving will be offset by the proposed 75 per cent. examination charge, which on current figures would be £2·93. Even after allowing for that, the cost of examination and treatment in the case that I have mentioned would be


£13·57 compared with £14·20 for the treatment alone on the basis of current charges. We estimate that some 2 million courses of treatment, including the proposed examination charge, will cost less than they do currently. The charges for extensive and more expensive treatment will generally be higher, and the net result of that will be, in our view, to set the signals much more clearly in favour of those who attend a dentist regularly and take proper care of their teeth.

Sir Barney Hayhoe: My hon. Friend has talked about regarding the Government's proposals in the round. Does he recognise that some of us who are generally very supportive of the main provisions in the Bill, and who will be voting for the Bill's Second Reading this evening, are sharply opposed to charges for sight tests and dental examinations? We are extremely concerned also about the mounting and increasing difficulties that are facing many hospitals and district health authorities, which have been spotlighted by the important statement of the three royal colleges which has been reported today. Does my hon. Friend recognise that clause 4, which refers to giving greater freedom to district health authorities in raising income, is superficial and peripheral to the fundamental and central problems that have been highlighted by the presidents of the royal colleges, which demand the urgent attention of DHSS Ministers and my right hon. Friends the Chancellor of the Exchequer and the Prime Minister? That should be the message from this House.

Mr. Newton: My right hon. Friend has referred to the proposals in clause 4, with which I shall deal later in my speech, and generally to the proposals which I have been outlining, which are perhaps not related directly to hospital and community health services, and described them as peripheral. It is clear to anyone who examines the pressures on the Health Service that it would be wrong to ignore or dismiss any reasonable source of enhancement of the resources that we can put into health care as a whole. That is what I have had in mind—I hope that this will be the view of the House generally—in judging these proposals. We all know that the potential for spending on health is literally infinite. Therefore, we all have a duty to consider every legitimate way of garnering resources to spend on health services.

Mr. Peter Fry: My hon. Friend has referred to those who are able to pay. Will he accept that there are many pensioners whose income is slightly above the supplementary benefit level who will find it extremely difficult to meet the new charges that are embodied in the Bill? Will he undertake to examine the present exemptions from charges and give consideration to whether they could be widened to take account of the difficulties that will be faced by those on very modest incomes?

Mr. Newton: I note what my hon. Friend says. I was about to emphasise that all existing exemptions — I know that this does not meet his point directly—from treatment charges will extend to examination charges. In other words, neither will be paid by children, students, those on low incomes, including the elderly, expecting and nursing mothers, and certain other groups. We are talking primarily about those on supplementary benefit or income support.
I recognise the reasons why my hon. Friend has introduced that point. Let me say, in general terms, that the objective of the Government's policy in relation to those over retirement age—which is clearly reflected in the measures that my hon. Friends concerned with social security have been introducing and carrying through in recent months and years — is to build on what has already notably occurred in recent decades: a steady improvement in the general standard of living of those over retirement age, not least with the development of occupational pensions.
I believe that the proper strategy of Government policy — and it is the strategy of our policy — should be to continue to build up the capacity of people in retirement to make choices and decisions for themselves, and thus enhance their independence. It follows from that that when public resources are to be applied by way of exemptions or special concessions, it is right to focus them on those who have not the advantages of, for example, the development of occupational pensions, and are — by definition—too late to benefit from what we are now seeking to do. That, I believe, is the right approach in this and other matters.

Mr. Robert McCrindle: While I accept what my hon. Friend has been saying about the desirability of encouraging those who are able to contribute to do so, will he take on board that many of us who will be voting for the Bill's Second Reading this evening for that very reason nevertheless feel strongly that, if it is impossible for the individual to make a contribution towards health care and only the Government remain capable of providing adequate resources, we should look to them progressively to do so in the weeks and months ahead? Many Conservative Members would be forced at this point to endorse the call by the presidents of the royal colleges this morning.

Mr. Newton: Let me say for the third time that I note what my hon. Friend has said, and ask him to note what I said to my right hon. Friend the Member for Brentford and Isleworth (Sir B. Hayhoe) a few minutes ago. I also ask him to recognise that it is too simple by half to associate all the pressures faced by the expanding Health Service solely with demand for additional financial resources.
I thought that one of the weaknesses of the statement issued by the presidents of the royal colleges last night was that it contained little or no serious discussion of the complex causes of some of the difficulties, including, for example, the nursing shortages which have been acknowledged recently in the Birmingham area —[Interruption.] The hon. Member for Derby, South (Mrs. Beckett) says that that has to do with money. But the cardiac clinicians who wrote to my right hon. Friend the Prime Minister at the beginning of last week, in a letter that gained some publicity in the press, made it clear that they felt that they could afford to pay intensive care nurses more within their existing budgets. They did not suggest that it was an overall resource problem; they suggested that it was a question of the structure of pay. We are tackling that through the so-called clinical grading review, on which I hope negotiations are nearly completed. That will give us a basis, through the subsequent recommendations of the review body, to tackle the problem in the way in which it needs to be tackled—in relation to the pay and grading of nurses.

Mr. Jerry Hayes: My hon. Friend is absolutely right to say that we must examine the restructuring of nurses' pay. However, let no one be deceived into thinking that it is just because of pay that 30,000 nurses are leaving the profession. They are leaving because they are demoralised.

Mr. Newton: My hon. Friend is oversimplifying matters in the same way as the statement by the presidents of the royal colleges. As was made clear in the debate in the House the week before last, no one suggests that there are not problems and pressures in the Health Service—as there have always been—over meeting demand. I do not try to dismiss those problems, any more than I did in that debate, or during the past few minutes. I ask in return only that my hon. Friend accepts that they are complex problems, which are often reduced to excessive simplicities by some of the statements that are put out.
Clause 7 of the Bill broadens the scope of the community dental service, and gives health authorities discretion to redirect the service's resources away from the routine treatment of children—who can be, and for the most part are, looked after in the general dental service —and towards providing health education for children in schools. We are also looking for new contractual arrangements, such as a continuing care, contract and capitation, which — subject to negotiations with the profession—will enable general dental practitioners to devote more time and resources to preventive work with their child patients.
I am bearing in mind, Mr. Deputy Speaker, the injunction from Mr. Speaker about brevity. In conjunction with the profession, we shall be launching a dental health testing campaign to promote dental awareness and regular attendance. The campaign will be directed in particular at young people in inner-city areas, where the standards of dental health are still some way behind those in the rest of the country. We shall also be taking a step designed to enhance the quality of treatment—one step among many, but a legislative step. Clause 9 provides increased powers for the Dental Estimates Board to survey and research norms and standards of treatment, and to deal with dentists whose work appears to be at variance with those standards. The White Paper also referred to our intention to consult the profession about a new counseling and monitoring service of dental practice advisers, which we hope will contribute to the improvement of services.

Mr. Dalyell: Why does the Minister think that the British Dental Association has circulated among many of us a powerful memorandum opposing examination charges for adults? Does he agree that charges will mean that people will go to the dentist less regularly, and that, ultimately, the expense will mount?

Mr. Newton: I do not find it surprising that the British Dental Association has circulated such a document. However, I disagree with its assessment of the effect of the proposals, especially against the background that I emphasised, possibly at excessive length. The net result is likely to be the provision of significant ranges of treatment — even with the examination charge — at lower costs than are now incurred; and, therefore, greater incentives for people to visit the dentist regularly while they still need modest treatment, rather than leaving huge problems to build up.
Clauses 10 and 11 relate to the general ophthalmic services. The first confines free National Health Service sight tests to groups which we have specified: children, those on low incomes, young people in full-time education and those who are registered blind or partially sighted. Those groups account for an estimated 30 per cent. — nearly one-third — of such tests. For the remainder, however, free NHS sight tests will cease to be available.
I should make it clear that there is no question of the Government setting or imposing a particular charge. The figure of £10, which has been quoted fairly widely, is simply the amount that we currently pay for such a test by an ophthalmic optician. For a test by an ophthalmic medical practitioner, it is rather less—just over £6, In the light of experience—following the end of free NHS glasses—with vouchers being provided for the priority groups whom I have mentioned— we can sensibly expect that the extension of competition, which has both reduced prices and notably increased consumer choice for spectacles, will restrain charges. Given that even those who already need glasses visit the optician only once every two or three years, I see no reason to suppose that people will be deterred in the way that has been suggested.

Mr. Robin Cook: Let me remind the Minister that when the House last discussed the matter the previous Secretary of State for Health and Social Services, the right hon. Member for Sutton Coldfield (Mr. Fowler), said:
we also believe that the access to a free sight test is important in detecting serious eye disease." —[Official Report, 20 December 1983; Vol. 51, c. 295.]
What medical advice—I stress the word "medical"—has the Minister received that has encouraged the Government to change their view, and no longer to believe that that is important?

Mr. Newton: I shall comment on screening in a few moments. However, I must point out to the hon. Gentleman that we have been seeking to expand and develop our health services as a whole and that we have placed great emphasis on the primary care services. We have rightly kept that policy under review. We launched the primary care consultation, and we have now published the primary care White Paper and this Bill. We have come firmly to the conclusion that we wish to undertake further development of these services in the interests of the general promotion of good health and the prevention of ill health. In the context of furthering and continuing that development, we have thought it legitimate to bring this proposal before the House. It will contribute to the resources that we need to carry out the other developments that we believe are worth while. I make no apology for the fact that we have done that.

Mr. Cook: I repeat my question: what medical advice did the Government receive on that point?

Mr. Newton: I repeat that I shall say something about screening in a few moments.
Clause 11 safeguards competition, which has had a significant effect by reducing the price of spectacles and increasing choice. We believe that that will restrain the cost of sight tests. We propose to safeguard competition by requiring the optician after a sight test to give the patient a prescription, if glasses are needed, so that he or she can shop around for glasses, as can be done now.
I am aware—the hon. Member for Livingston (Mr. Cook) echoed this point in his interventions — that


suggestions have been made that our proposed changes will diminish the role that is played by sight tests in screening for other conditions. The extent to which that argument stands up at all depends on expecting people to be deterred from seeking eye tests. There is no reason to expect that to happen. Sight tests will continue to be conducted at least to the same standards, although opticians may decide in practice—partly because of the competitive pressures to which I have referred—to offer a wider range of tests than is available under the National Health Service. It is a professional requirement of the General Optical Council that the optician should refer a patient to a doctor if he detects glaucoma or diabetic retinopathy. That arrangement — clearly on medical advice—will continue.

Dame Jill Knight: If opticians are to be encouraged to conduct different types of tests, with some being not quite so thorough as others, who will be responsible if, during a less than thorough test, early signs of diabetes are missed? Will the optician be responsible, although he has been encouraged by the Government to carry out a less than thorough test on his patient, or will the Government be responsible?

Mr. Newton: I think that I shall carry my hon. Friend, who knows a great deal about these matters, with me if I acknowledge that the extent of the tests that are carried out by opticians already varies from one practice to another. If it is felt that further steps should be taken either to tighten up the procedures or to impose precisely what should be done, that could be considered. I do not dismiss my hon. Friend's point, but I am uneasy about the apparent willingness to rely for the screening of some conditions, in particular diabetes, on the chance that people go to their optician. Our proposals for general practitioners are designed to encourage, particularly in relation to the very young and the elderly, the systematic overall health screening of those who are most likely to be at risk. It is worth considering whether that is a better and a more sensible approach to these problems than to rely on people going to their optician.

Mr. Richard Holt: Will my hon. Friend accept that I have a typical diabetic condition that was found when I went for an eye test? I am not elderly and I am not a child. In those circumstances, would I have had the benefit of a sliding scale option? How much would the minimum charge have been and would the optician have given me that option at the beginning or at the end of the diagnosis?

Mr. Newton: I am not, I am afraid, absolutely sure that I have understood the last part of my hon. Friend's question. The charge will depend on what the optician decides to charge. My view is that the pressures of competition, which have significantly reduced the price of spectacles, will similarly restrain, and possibly entirely eliminate, the charges for eyesight testing. However, that is for opticians to decide within a much freer market than exists now. I believe that it will have the same beneficial effect as the move to vouchers has unquestionably had.

Mr. Holt: Am I to understand that each optician will be able to choose what charge he makes, that that charge

could be nil, if he so chooses, and that the reimbursement by the Government will be according to a sliding scale that the Government will fix at another time?

Mr. Newton: I have already emphasised that there is no question of the Government setting or prescribing particular charges. We shall continue to discuss with the profession the arrangements for reimbursing opticians for eyesight tests that remain free NHS eyesight tests —according to current figures, about 30 per cent. Where there is no question of a free NHS eyesight test —roughly the other 70 per cent. — it will be for the optician to decide how much he wants to charge. I make no secret of the fact that my guess is that in many cases the charge will be rather less than the amount that is paid to opticians for carrying out those tests now. Indeed, it would be very surprising if that were not the case.

Mr. Robin Maxwell-Hyslop: My hon. Friend says that he does not expect people to be deterred by charges for what was previously free. Since that is contrary to what any person would expect the consequence to be, on what objective evidence are his expectations, which seem to be so improbable to common reason, based?

Mr. Newton: My hon. Friend will accept that it can only be a matter of judgment, in the light of the experience that we already have of the abolition of free NHS glasses and the introduction of the voucher scheme. We were told that large numbers of people would be frightened and would not have spectacles. I know of no evidence that that has occurred. We were also told that opticians would never be able to provide spectacles that were as good as or better than the old NHS ones at the sort of price that the voucher values represent. One only has to visit one of the attractive spectacle stores that have now been set up to find that such establishments are offering a significantly wider range of much more attractive spectacles that come within the voucher values. I accept that it is a matter of judgment, and I hestitate to quarrel with my hon. Friend's judgment, but in this case my judgment differs from his.

Sir Peter Hordern: Is it not possible that the charges are most unlikely to be as much as £10 a visit, and is it not possible that more people will be encouraged to visit their optician? As for the complaints by the principals of the royal colleges, is it not a fact that there are now twice as many nurses and doctors as there were 20 years ago, when these eminent people first started in practice, and that if only they had run their hospitals better and achieved better savings, and if there were not so many hospitals, the Health Service would be a great deal better off?

Mr. Newton: I am not sure that I can vouch for my hon. Friend's statistics. Mine usually go back to 1979 for reasons about which the House will speculate. However, I confirm my hon. Friend's view. One need only consider the different periods of day surgery care from health authority to health authority, and, indeed, from hospital to hospital, the differing periods of time that patients spend in hospital following certain procedures or the relative costs of different hospitals and different clinicians to know that there is a good deal of room for improvement among all who are connected with the Health Service. I hope that doctors will reflect on that.
In addition to the contributions to the general improvement in health care services, especially screening


and preventive services, with which we expect the resources released by the changes to assist, I should emphasise that the changes will enable us to extend other important services related to eye care. We propose to extend the voucher scheme to help adults who frequently break their glasses because of physical or mental disability. Negotiations will shortly begin with the profession about widening the National Health services to enable practitioners to provide a sight testing service to the housebound. I know that many people who are concerned with community care attach great importance to that point, which will be of real assistance to many elderly people. In addition, the value of vouchers that are available to those who require complex and expensive lenses will be given special consideration to ensure that that group of patients is not placed at a disadvantage.
I have already taken quite some time from the House and shall cover the remaining clauses briefly so that, at least, I shall have given the House some idea of what they contain. Some are principally technical measures to tie up loose ends that arise from earlier uncertainties.
Clause 14 anticipates the integration of the artificial limb and appliance services into the National Health Service in 1991. That has the effect of maintaining continunity of employment to civil servants who choose to transfer to the National Health Service.
Clause 17 confirms the legal basis of fees for licences that are issued under the Medicines Act 1971.
Clause 16 fills the gap in the limited powers of the Secretary of State to make grants for the training of local authorities' social services staff in England and Wales. That may sound a small point, but one aim is to enable us, at some appropriate moment, to put resources into improving the training of staff concerned with child abuse, for which we think we currently have inadequate powers.
Clause 15 removes the power of local authorities to charge health authorities for the services of social work staff. When the National Health Service was reorganised in 1974, local authorities were made responsible for employing social workers and health authorities for employing doctors and nurses. Resources were transferred centrally at that time from the health budget to local government grant arrangements to reflect that change of responsibility. There is no justification for retaining the anomalous powers for local authorities to make the charges. Subject to passage of the Bill, we intend that that should take effect at midnight on the day of publication, 26 November.
I return, as I said I would, to the issue of income generation by health authorities. The Bill is intended to assist health authorities in creating new opportunities to generate additional resources and, not least in connection with the points made during the past half hour by my hon. Friends on the Back Benches, to improve health care. The Bill gives health authorities new powers to supplement their resources by making, for example, better use of their facilities. They will be able to take greater advantage of opportunities to lease space to commercial outlets, such as shops or hairdressers. If they wish, they could sell advertising space in the hospital or at other premises. They will he able to consider providing completely new facilities such as health clubs, for which they can, quite sensibly and properly, make charges.
Several authorities have already made a modest start, for example, by charging taxi companies for the installation in hospitals of free taxi-phones for use by

patients and visitors, or by recovering and selling the silver from used X-rays. The Bill is designed to enhance such opportunities and to make it clear, in the statute, that such activities can only be undertaken provided that they do not interfere, in any way, with the main duty, which is to provide services to patients under the National Health Service.

Mr. Holt: Will my hon. Friend give way?

Mr. Newton: Yes, but then I must get on.

Mr. Holt: I am grateful to my hon. Friend for giving way. If an entrepreneurial health authority holds bazaars and all sorts of events and raises a lot of money in the next year, will it suffer a deflation of its allocation by the regional health authority or will it be allowed to keep that money, in addition?

Mr. Newton: I intend to make it clear to regional health authorities, without attempting to dictate every detail of their allocation policy, that I expect them to ensure that district health authorities are not put in a position in which it does not seem worthwhile to engage in entrepreneurial activities because they fear that they will not gain or benefit from them.

Mr. Sam Galbraith: Will the Minister give way?

Mr. Newton: Yes, but this may have to be the last time that I do so because otherwise many hon. Members will be unable to speak.

Mr. Galbraith: The Minister said that those other functions must not interfere with patients and subsection (5)(a) of clause 4 state that they should not,
to a significant extent, interfere with the performance".
Will he tell us how he will ensure that they do not interfere with performance?

Mr. Newton: The sort of schemes that we would be prepared to countenance will be a matter for monitoring by the Department and by regions. We intend to set up a central unit to distribute the information and to assist health authorities in such matters. I re-emphasise, because I do not want this to be misunderstood, that there is no intention of permitting activities that could be seen as detracting from the services provided under the Health Service to those to whom the health authorities have a responsibility. The purpose is to gain additional resources for the continued improvement of the National Health Service.
The clause gives health authorities much greater freedom as to the way in which they set charges for private patients. Currently, authorities can only recover through charges the costs of the services provided for private patients. We intend that in future they should be able to set charges according to the prevailing market conditions. That should enable authorities to increase their income from such services.
Partly because I have given way so much, I have taken rather longer than I would have wished and shall conclude briefly. In many important respects, the Bill paves the way for the implementation of significant improvements in primary health care in this country, for increasing consumer choice and improving the quality and quantity of services overall. It also provides those new powers that will make a useful contribution to the further development of hospital and community health services. In that sense,


it will be a significant and useful step forwared in the continued development of policy for improving the Health Service in this country and, therefore, I commend it to the House.

Mr. Robin Cook: Under this Government, the straightest way to the heart of any Bill is to turn to the financial memorandum. From the financial memorandum we learn that there will be no significant effect on public sector manpower, but that there will be significant net savings on public expenditure. I congratulate the Minister on his nerves of steel. Against a background of financial crisis in the Health Service, it takes a thick-skinned and impervious Government to come to the House of Commons to ask it to pass a Bill that will further reduce Government spending on the National Health Service.
I saw the contrast between the needs of the Health Service and the priorities of the Government graphically illustrated yesterday on the front page of my Sunday newspaper. Side by side with the report of the death of baby Barber there was a report that the Chancellor of the Exchequer was considering a 2p cut in the basic rate of income tax next March, plus a cut of 10p in the income tax of top people. Apparently that is because of what is described as the "prosperous" state of Treasury revenues and the "negligible" need for public borrowing next year.
It costs £3 billion to reduce income tax by 2p, leaving aside the extra gilt for the top-rate payers. One third, or even one sixth, of that sum would transform the situation in British hospitals. If the Chancellor of the Exchequer has such money to spare, it is the duty of the Minister for Health to get it for the National Health Service. It is a function of Government to make a judgment between competing priorities for resources. However, only a Government who have abandoned all pretence of measuring social need could persuade themselves this winter that tax cuts should take priority over spending on the National Health Service.
The point was expressed yesterday succinctly by Philip Barber, who was interrupted at a marathon, sponsored game of pool to be told of his son's death, when he observed:
There is something wrong in a society which needs me to play pool so that babies can have operations to save their lives
Yet the Bill confirms that even the Ministers responsible for the nation's health have agreed to share the priority of cutting spending rather than meeting need.

Mr. Hayes: I am sure that the hon. Gentleman would not wish to mislead the House in any way. When he talked about the financial and manpower effects he talked about significant net savings, but he did not go on to say that that was because the General Practice Finance Corporation will be a limited company and will not be counted in the public sector borrowing requirement. I am sure that he would like to explain that.

Mr. Cook: The hon. Gentleman refers to clauses 1 to 3, to which I shall refer in a moment. If he re-reads the passage that talks of significant net savings in public expenditure, he will recognise that it refers to clauses 1 to 13, which go well beyond clauses 1 to 3.
Clause 13 is likely to be the most profound measure, because for the first time it extends cash limits to the family

practitioner service. I noticed that the Minister said that that would be a more flexible system than the present one. We are surrounded by abundant evidence of what this flexible system of cash limits has done to our hospital service. The rest of the nation is appalled at the consequences of this flexible system on the hospital service, yet apparently the Government are so pleased with the results that they propose to extend the system to general practitioners. Clauses I to 3 promise considerable savings to the public sector borrowing requirement, never mind that The Observer tells us that the PSBR is also negligible. Apparently it is the first duty of the Minister for Health to find still more savings to make it even more negligible.
The savings arise from a proposal to privatise, not the family practitioner committees— the Government have not yet reached that stage — but the General Practice Finance Corporation. It was set up because GPs had difficulty in obtaining commercial loans to purchase property in areas of poverty and under-privilege; in other words, in areas where the banks were reluctant to lend. That remains the distinctive contribution of the GPFC. It is astonishing that in a package that we are told is designed to improve primary health care the Government should wash their hands of the major provider of funds for premises in inner cities, where there is the greatest need to obtain more premises and to modernise existing ones.
The Government considered privatising the GPFC in 1984 and rejected the idea. The Minister's predecessor came to the Dispatch Box on Report on the Health and Social Security Bill and positively preened himself on keeping the corporation in the public sector. He said:
It shows what a flexible and non-ideological Government we are."—[Official Report, 2 May 1984; Vol 59, c. 366.]
By the same token, we can only conclude from today's measure that we are faced with an inflexible and ideological Government. The savings from this bit of ideology are small beer, because the Government have already so reduced the borrowing limits of the corporation that it is allowed to spend only £10 million to £12 million a year. The Government will now receive 15 times that sum in increased income from the proposals on new charges for teeth and eyes.
I shall flag an anxiety raised by several members of the BMA about the breadth of clause 8. Mysteriously, reference to dentists and dental charges vanishes in subsection (2). When the Minister replies, will she clarify the scope of clause 8 and confirm that she is not giving herself powers to introduce by regulation charges on the services of general pracitioners? I shall wait in expectation of her reply when she is briefed.
What we know about the clause is bad enough. It provides for a new charge on having one's teeth examined. Since 1948 teeth have been examined free under the NHS as a matter of principle. The Government propose to raise £50 million by abandoning that free examination. One is bound to observe that they sell their principles cheaply—

Mr. Nicholas Bennett: As the Labour Government did in 1951 with the introduction of prescription and dental charges.

Mr. Cook: With the greatest respect, no previous Government, of whatever colour, have introduced a charge for the examination of teeth. Nowhere are we favoured with an explanation of how it will help to prevent


dental disease by deterring patients from going for a regular check-up, and deter them it will. I assert that with confidence because, thanks to the Government, we have experience of what happens when dental charges are hoicked up. In April 1985 the Government increased dental charges by 25 per cent. Over the subsequent year the number of fillings fell by 5 million, the treatment of gum disease fell by I million and root treatments fell by more than 100,000. By contrast, the number of patients opting for the cheaper treatment of extraction increased by 5 per cent.

Mr. Richard Tracey: rose—

Mr. Edward Leigh: rose—

Mr. Cook: I shall happily give way when I have finished this point.
It need not surprise Conservative Members that increasing charges has that effect on demand. After all, they, more than anybody else, have put their faith in the market mechanism, and they should be gratified to learn that that faith is justified when patients respond to the pricing signal by staying away from surgeries or opting for the cheaper option of extraction.

Mr. Leigh: What happened to the nation's teeth when the Labour Government increased the cost of routine dental treatment by 150 per cent. in 1977?

Mr. Cook: I cannot answer that, but I can say what happened at the local elections, because I was canvassing on the night when that was announced. I can assure the hon. Gentleman that several colleagues and I resisted that charge when it came before the House, and if we had had the support of his colleagues we would have defeated it.
Many will undoubtedly now stay away when they receive the reminder for a six-monthly examination. It is worth remembering that that examination has importance in health care well beyond sound teeth; the dental examination can reveal other medical conditions. To take one topical disease, it is likely that some AIDS carriers will first be detected through thrush of the gums when they present themselves to a dentist. It is important not only for them, but for the rest of the community, that they are not inhibited front obtaining early diagnosis of that condition.
There is also the wider issue of the structure of the charges. The Minister prided himself on the fact that some people will pay less under his new charges, and that may be so. I am prepared to concede that some people may have a smaller bill, but the Minister cannot stand at the Dispatch Box and pretend that that is some sort of general rule. After all, we know that he is budgeting to expect £85 million more in charges from those who visit the dentist, so, demonstrably, most will pay more. In particular, the 100,000 who at present bump against the ceiling of £115 on charges will now bump against the ceiling of £150 per charge.
The Minister said that the charge would be proportional to the cost, but no such proportion is set out in clause 8. On the contrary, clause 8 is drafted in alarming terms which would allow the Minister to recover the whole cost of the charge. I suppose that 100 per cent. may be passed off as a proportion of a sort, but it is hardly what most people understand by the use of the term. Clause 8 gives the Government the power to abolish by order all public support of NHS dental treatment. It puts the dental

service on the slipway to an entirely private marketed service, and if anyone concludes that that is fanciful, I would ask who would have thought eight years ago that that is precisely where the NHS optical service would now be?
That brings me to the key proposal in the Government's preventive approach to eye care, which is to introduce charges for eye tests. The Minister said that it would not necessarily cost a tenner. A tenner happens to be approximately what optometrists are paid—£9·30 to be precise. Anything less than that would leave them out of pocket. The Government may argue, as the Minister argued, that they could opt for a lower income and therefore suffer a lower charge
The Minister referred to the market. Markets seek equilibrium when supply and demand are in balance. I should not have to point that out to such a disciple of the Prime Minister's economic philosophy. It would be a curious market which found it equilibrium at the point at which all demand was met. By definition, if the Minister is leaving it to the market to settle the charge, some demand will not be met because it cannot meet the charge. There was no hint in the consultation document of that proposal. There was not a breath of it in the Conservative party manifesto—a point of some relevance.
Mr. Ian Hunter, the general secretary of the Association of Optical Practitioners, told Conservative Back Benchers that most of them had voted for the Government. No doubt optometrists are men of strong political convictions who would have done so anyway, but it is a pity that the Conservative party did not trust them enough to tell them in advance what they were voting for.
The majority of optometrists' clients are pensioners, and pensioners need the eye test most, and they need it most often. Six million pensioners will not qualify for a free eye test. Many of them simply will not go, or will not go as often as they should. They may save a tenner, or perhaps a fiver if the market system operates, but they may also lose their eye sight. The eye sight test is a misnomer. Optometrists offer a full examination of the back of the eye, and they require specialist training and special equipment. They can detect serious health risks such as diabetes and hypertension.
My hon. Friend the Member for Aberdeen, South (Mr. Doran) was in contact with me over the weekend, following a visit from a constituent who visited an optometrist about three months ago. The optometrist examined the back of her eye and immediately arranged for her to see an eye specialist, who referred her to a neurosurgeon. Within a week of her examination, she was operated on for a brain tumour and was advised by the neurosurgeon that had she waited for another two weeks it is likely that she would have lost the use of her legs permanently. In that case a very serious medical condition was revealed by the eye test. I must add that the constituent in question was quite frank in saying that, on her wages as a cook, she would not have gone for that test if she had had to pay a tenner.
The damage that will arise from the introduction of charges is perhaps best illustrated in the case of glaucoma. Three out of four cases of glaucoma are detected by the eye test. I cannot do better than read the observations of the International Glaucoma Association, which says that it
can only conclude that either the Government have not been well advised; or that they have deliberately decided to brush


aside as of no consequence the certain increase in the number of people with glaucoma who will not be discovered until the disease is well advanced.
I listened with interest to the interventions of the right hon. Member for Brentford and Isleworth (Sir B. Hayhoe) and of the hon. Member for Brentwood and Ongar (Mr. McCrindle) who are no longer in the Chamber. It would have been nice if they had stayed and participated in the rest of the debate, as they feel so strongly. They said that, although they would vote for the Bill, the Minister could not expect them to support the measure.
I have to tell those hon. Members that the Minister made a very interesting statement of particular relevance to Conservative Back Benchers who claim to disagree with his proposal. The Minister said that he believed that adults with means of their own should make up their own minds and make choices for themselves. I believe that that is precisely what those Conservative Back Benchers who are unhappy with the proposal must now do. It will not do for them to stand up in the House and say that they disagree with the Bill and then go into the Lobby and vote for it.
Clause 4 gives expression to the Government's latest fad, which they have termed income generation, and provides a new place in district management teams for a marketing director whose role will not be meeting health needs, but that of finding the sponsor who will pay most to get his name on nurses' uniforms — the Adidas solution to Health Service funding. It is not an optional course, which is being offered to managers as light relief from the stress of being unable to meet health needs. Clause 4 authorises the Secretary of State to direct health authorities to market their services. For good measure, it adds that it is their duty to comply with such directions.
The hon. Member for Langbaurgh (Mr. Holt) made a penetrating intervention, if I may say that without prejudicing his career, when he asked whether the Minister would allow health authorities to keep the fruits of their marketing. He received a particularly Delphic response. I have in front of me the words that the Minister used when he was asked an identical question at a press conference last week. His words on that occasion were slightly less Delphic. He said:
Inescapably, we have to look at the totality of resources available from all sources.
The hon. Gentleman feared that that meant that the Minister would deduct from the allocation to health authorities the revenue that they had raised from marketing. I have to warn the hon. Gentleman that it will be worse than that. After the Minister has taken his powers to direct health authorities to market the services, and after he has taken the power to oblige them to comply with those directions, he will assume that they are obtaining income from marketing the services, whether or not they are securing that income. It is a fraud on the House and on the nation to pretend that extra revenue will be available for patient care.
Let me make it clear where the Opposition stand on that matter. We believe that the test that has to be applied to marketing services is whether they will improve the service to the patient. If a spot of franchising provides greater variety in the cafeterias, that is well and good. If those cafeterias are run on the principle of a healthy diet, that is even better, although that rules out 90 per cent. of the fast food chains in Britain.

Mr. Holt: And in the House of Commons.

Mr. Cook: In the House of Commons, too. What is wholly dishonest is to pretend that clause 4 will unlock a chest of gold that will plug the yawning gap in hospital finance.
Last week the Minister objected to my description of this as tuck shop economics. Ken Grant, the manager of the City and Hackney health authority, who has done more than anyone else to generate income, expressed it in more blunt language than I dare use. He said:
In terms of what the NHS needs, the money we are raising is peanuts. It's just that at the moment peanuts are bloody useful
After three years the peanuts will amount to £70 million in a full year. To put that in perspective, it is less than half the £168 million by which the Government have underfunded nurses' pay in the past year alone. It is sheer effrontery for a Government who cheated the health authorities on that scale now to claim the credit for allowing them to raise half that money in the market. The basic reason why we are suspicious of clause 4 is that, eventually, the pressures on hospitals to make profit will make the patient pay. Nearly two thirds of clause 4 is about charging patients.
It might be salutary to recall at this point the crushing failure of the Government's previous intervention on charging patients, which encouraged hospitals to expand pay beds by one quarter over six years. Unfortunately for them, those six years turned out to be the same period in which the number of patients wanting pay beds fell by one third. The legacy of that colossal misreading of the market is a mountain of bad debt. Health authorities are writing off £500,000 in bad debt from private patients who slipped to the front of the queue into pay beds and failed to pay for them.
Despite that lesson of history, the Government now want to encourage health authorities to invest still more money in that loss leader. I have evidence of what the Minister has in mind. I understand that on Wednesday, or later in the week, at a press conference he intends to reveal a deal which the Government have struck with Bioplan Holdings to develop private day units in NHS hospitals. One of those is the Hope hospital in Salford, where Bioplan is to build a 12-bed new day centre unit. Another is the Churchill hospital in Oxford, where Bioplan is to equip an existing Health Service day surgery unit and provide 15 private beds. Those are the first two out of six such deals around the country. Each of them will have the capacity to carry out 10,000 operations.
That reflects the trend in America for fast in and out day surgery as the basis of private care—the "Kwik-Fit" approach to surgery. It breaks new ground in reducing health care to a market commodity. It will mean that NHS hospitals and private hospitals will occupy the same sites — in the case of the Churchill hospital, the same building. They will share common staff. It is not even clear whether consultants will operate in their own time or in the time paid for by the district health authority. They will share common laboratory staff—at any rate until such time as the Government privatise the laboratories.
The absurdity of the position is that the district health authorities will provide the sites, lend the staff, run the back-up services and must then pay Bioplan for the treatment of the patients. Of course, the deal has been stitched up behind closed doors, which is the very antithesis of market forces. There was no open tender here.
It is a flagrant case of favouritism — and what a favourite to have chosen. Bioplan shares its directors with the British subsidiary of the Hospital Corporation of America. The vice-president of that corporation has observed with engaging frankness:
We try to maintain a low profile when we enter a country because we don't want it to appear that — here is a big American company to take over the health care system.
With equal candour, two years ago the founder and controlling shareholder of Bioplan stated his health care philosophy at a Financial Times conference. He said:
I don't apologise for being commercial—the bottom line to me means profit.
How fitting that this Government should choose such a company as a partner. How perfectly that demonstrates where we are going with clause 4 and the joint priorities of that company and the Government.
Meanwhile, back in the state sector, every day we see more clearly the reality of the Government's commitment to the NHS. In Birmingham the reality of health care under the Government is a charity appeal for £500,000 to cover a corridor from the operating theatre so that ill babies need not be wheeled through the mud. In Leeds the reality is parents clubbing together to fund a registrar's post in a children's cancer ward.
At the weekend it was the turn of the royal colleges to issue an unprecedented joint statement. I have not been charged with the health portfolio for as long as the Minister has, but even if I had the years of experience that he has I hope that I would not presume to tell the presidents of the three senior royal colleges that they had not grasped the complexity of the issue. The three presidents said:
In spite of the efforts of doctors, nurses and other hospital staff, patient care is deteriorating. Acute hospital services have almost reached breaking point.
That statement is a damning indictment of the state of our hospitals this year. The statement demands a response from the Government that matches the magnitude of the crisis that it depicts. That response will require vision and clear-headed choices between priorities. It will require a readiness to square up to providing the resources to do the job adequately. Instead, the House is offered this tawdry Bill about putting petrol pumps in hospital forecourts and charging the elderly to have their eyes examined.
The measures are objectionable enough in themselves. The Bill that contains them is doubly objectionable because it is a pathetic and fatuous irrelevance to the real crisis in the Health Service. We will vote against it tonight with contempt.

Sir David Price: Following Mr. Speaker's injunction to make brief speeches, I hope that the hon. Member for Livingston (Mr. Cook) will forgive me if I do not immediately answer some of his important points, especially the latter ones. I hope to take up some of them during my brief contribution.
I am the only member of the former Select Committee on Social Services, which spent most of last year examining primary health care, who is present for this debate. I thank my hon. Friend the Minister for agreeing, at least in principle, with most of the recommendations in our report. It would be churlish of me not to extend similar thanks to the Goverment for their White Paper. It is

important for us to realise the commitment that they have made. In the preface to the White Paper, the four Secretaries of State say that we must
shift the emphasis in primary care from the treatment of illness to the promotion of health and the prevention of disease.
To succeed, that shift will require extra resources. Illness will not just vanish because we decide to work for a healthier nation.
In the long term, if we place more emphasis on the prevention of illness and immunisation, it will be reasonable to expect a reduction in known ailments, with known causes where they are known to be preventable. Former killer diseases such as smallpox, scarlet fever, diphtheria and tuberculosis have been nearly, if not completely, eliminated through public health campaigns, immunisation and the development of antibiotics. Thus, there is an historical basis for the long-term hope that prevention will reduce the incidence of illness. But we have no chance of doing it quickly. Therefore, the extra activity that we hope will come into primary care as a result of the White Paper will require further resources. We know that resources are already under strain, and the hon. Member for Livingston drew our attention—if we needed it—to the statement from the presidents of the royal colleges.
What are the Government doing to provide extra resources? In his statement of 25 November, my hon. Friend the Minister for Health outlined the Government's commitment to putting more resources into primary health care. He reminded us that existing plans already provided for an additional £570 million in real terms by 1990–91. Today, he talked about £600 million. I do not know whether he was rounding up or whether we have got another £30 million out of him.

Mr. Newton: I started rounding down and said that we were committed to spending at least another £500 million. The programme of additional expenditure contained in the White Paper will take it from under £600 million to well over £600 million.

Sir David Price: My hon. Friend went on to say in his statement that the £570 million
will be further increased by the substantial extra resources that the Government will make available to finance the improvements that I have described today." —[Official Report, 25 November 1987; Vol. 123, c. 260.]
Paragraph 2.6 of the White Paper examines the Government's intentions and suggests that additional resources will be available. That puts a different light on the Government's proposals from what was said by the hon. Member for Livingston and by some of my hon. Friends. Will my hon. Friend the Under-Secretary of State who will reply to the debate spell out more precisely the Government's commitment to provide these extra resources? It is important for us all to know what that commitment is. I will carry the whole House with me when I say that to move forward in health promotion, the prevention of illness and immunisation—all the matters that were set out in the Select Committee report— we shall need extra resources. I believe that the Government are committed to making available those extra resources, but that message is not getting through to the public or to the House. Much of the debate so far has centred on the false idea that the Government are reducing resources.

Mr. Peter Thurnham: It seems a pity that that point has not got through to the


professionals. When the discussion document was put out for consultation, no suggestions were made about how the developments could be financed. The professionals were slow to come forward, but they were not slow to be entrepreneurial. My right hon. Friend the Secretary of State has said that the Health Service could consider other opportunities, but the professionals have not been slow to find other opportunities to boost their income. The Sunday Times said that consultants in the Bristol hospital were earning £60,000. Perhaps members of the profession will come forward with suggestions.

Sir David Price: My hon. Friend makes a useful intervention which goes rather wider than the scope of the Bill, but he takes me on to my next point. If, as a nation, we are to develop our health services as everybody wants, we must consider new methods of financing them. That takes up my hon. Friend's point.
We must not reject ideologically the use of charges, but we must ask what sort of charges should be made and whether they are acceptable medically. The hon. Member for Livingston made a very telling point. I could put the same point in the language of the Royal College of Nursing which said that we encourage free medical checks of all parts of our body by clinicians except our teeth and our eyes for which we will have to pay. This distinction requires a more detailed justification than we have had so far. I am not opposed to the concept of charges. It is an important matter and we must discuss which charges are relevant. No charge must be imposed which might reduce a citizen's access to services because he cannot afford them.

Mr. Galbraith: I do not agree with charges, but there are different types of services for which we can charge, for example, treatment, including prescription of spectacles, and screening. That is an important distinction. People would continue to take up preventive treatment, but they would not take up a screening test.

Sir David Price: I sympathise with the hon. Gentleman's point. Let me move from charging to my old hobby horse, which I do not apologise for raising again. We must aim at smaller lists for general practice. I have already quoted the Select Committee's recommendation on this matter and, with the indulgence of the House, I shall repeat it because it goes to the heart of improving the scope of primary health care. We said:
With an ageing population, earlier patient discharge from hospital—particularly of children, increasing opportunities for diagnosis in general practice to reduce referrals to hospital, as well as greater responsibility for the management of chronic disease in general practice and a greater emphasis on a range of preventive services, the case for further reduction in the GP list size seems unanswerable.
I believe that it is unanswerable. The measures necessary to implement the House's intention for better primary health care — the House supports the White Paper's intentions—must centre upon the reduction of list sizes.
If we wish to improve our primary health care, we must recognise that nurses should play a greater role than they have hitherto and that they are professionally competent to do so. I hope, therefore, that the House will agree with what we said in paragraph 60 of our report, which is clearly relevant to the Bill. We state:
There must also be better training for nurses and a proper career structure, if they are to perform an extended role in the

community. Steps need to be taken to recognise and raise the status of nurses working in primary care. Practice nurses need training specifically directed towards work in the community.
If the Government accept that view, why does clause 12 provide extra remuneration for training by doctors, but does not extend it to nurses? It would be an important improvement to the Bill if a clause to that effect were added.
In the same vein, why are the Government not taking advantage of the Bill
to permit nurses with appropriate training limited powers to prescribe and in defined circumstances to modify dosage"?
That was our recommendation 30 with which the Government agreed in principle. In their reply they said that they accepted the proposal, but that they would have to consult the professional standing advisory committees. It is nine months since we made that proposal and a good deal longer since Julia Cumberlege also proposed it. We must take advantage of the Bill because we do not have a Bill like this every year. Therefore, I hope that the Government will add a new clause to that effect.
There are many other matters with which I should like to deal. We issued a long report with 62 recommendations. I wish to put a few of our points in headline form because they are relevant to our debate. We must consider the role of other professionals in primary health care, particularly physiotherapists and occupational therapists. It is important to include social workers in the primary health care team. We must develop pathological and radiological services and bring them closer to the community, giving a quicker back-up to primary health care. The community hospital must support the general practice and act as a satellite to the district general hospital, thus linking the hospital service through to general practice. We must also consider how voluntary bodies fit into the scheme of health care. I wish to impress on the House the need for closer ties between hospitals and general practice. Those ties should be so close that there would be a seamless robe of care from the patients' bedside right through to intensive care, if needed. We do not make this any easier when we separate the family practitioner service from the hospital service. As my right hon. Friend knows, this is one of my hobby horses. Scotland shows a very much better example in these matters.
Occupational medicine has a contribution to make in improving standards of preventive medicine and promoting good health care. The private citizen in ordinary families provides most care. I remind the House that there are more private carers—as the House knows, I count myself among them—than all the professionals in the public and private sectors added together. It is worth reminding the professionals occasionally that we amateurs carry more of the heat and burden of personal caring than they do.
The Select Committee believed that new legislation had only a minor role to play in the improvement of primary health care. It was much more a matter of improved administration, better deployment of staff, more training, additional resources, and, above all, the will to succeed. Like my fellow Select Committee members, I came away from our inquiry optimistic about the prospects for better primary health care, provided that more resources went into the service. I was encouraged by much evidence of good practice in many different areas, including rural areas and inner cities.
I welcome the Bill and the White Paper. Unlike some other hon. Members who may speak in the debate, I view them with hope and optimism.

Mr. Sam Galbraith: The hon. Member for Eastleigh (Sir D. Price) made a number of interesting points. He knows that he and I do not agree on everything, but we have a meeting of minds on some things. We seem to spend our time in the House complimenting each other. He obviously has a very astute and sharp mind if he agrees with me.

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie): He understands.

Mr. Galbraith: Yes, he understands.
The hon. Member for Bolton, North-East (Mr. Thurnham) referred to consultants. Since I have been a Member of the House, I have heard veiled threats about consultants. The hon. Gentleman referred to consultants earning £60,000. Anyone who knows my background will be aware that I have been one of the greatest critics of consultants and some of their practices. My salary would not reach such a level because of my antipathy to private practice, which is the method by which such sums are earned. Many consultants will not indulge in private practice and I was one of them. I hope that we shall not hear any more contributions like that from the hon. Member for Bolton, North-East.
Although the Minister for Health has now left the Chamber, I thank him for allowing so many people to intervene in his speech. That was very laudable. Indeed, it was in stark contrast to the speech made by the Parliamentary Under-Secretary of State for Health and Social Security who, when she replied to the previous debate on this subject, did not allow anyone to intervene. It was odd that the hon. Lady would not allow interventions, especially when she misquoted me for purely party political purposes. I know that I am new to this House, but I would advise her that such action did not help her or her argument. When she replies today, I hope that we shall not hear any silly claims that the Government are responsible for the increased rates of survival of kidney transplant patients. That would do nothing to help the hon. Lady or her argument.
I was very interested to hear the comments of the hon. Member for Eastleigh about primary care and the way forward, and I agreed with some of them. The trouble with the Bill, as the hon. Member for Eastleigh almost admitted, is that it misses the opportunity to make a number of contributions in the right direction. This is a nasty little bit of piecemeal legislation which does not tackle what is at issue. The thrust of the Bill, that primary care should be directed towards the promotion of health and the prevention of disease and that GPs should take more responsibility, is correct.
I welcome a few parts of the Bill. I welcome the parts about doctors retiring earlier and the aspects of GPs issuing information leaflets about services on offer, for example, whether family planning is carried out or whether there is parking for disabled drivers. Those are worthwhile. However, as long as we continue to adopt a piecemeal approach to primary care, we shall not progress.
As the hon. Member for Eastleigh asked, why is the general practioner service still separate from the hospital

service in England? We could have brought the primary care services together under a health board incorporating family practitioners, primary care and community units. The health board could have pulled together the physiotherapists, dentists, social workers and GPs. It could have clearly planned a tip-top primary care service. It could have set standards and asked the GPs to follow them. If we wanted to allow financial inducements to practices, they should not have been achieved in this manner. They should not be applied for services, as that might produce unnecessary services. We could have identified a basic practice allowance for practices that were willing to follow standards and attainments set out by the primary care and community health board. The practices that did not wish to follow those standards would receive a smaller basic practice allowance.
I also accept that there is a need to reduce the size of practices to the ideal number of 1,700. Perhaps the Minister will tell us when she replies what in the Bill will induce practices to become smaller. The way to achieve smaller practices is to reduce the capitation fee for patients above the figure of 1,700 and reduce it further above 2,300. I believe that the Bill is a missed opportunity with regard to primary care.
I want to consider clause 4. It appears that not only the Labour party has trouble with clause 4. I will try to be brief as I understand that other hon. Members want to speak. Clause 4 refers to finding additional resources. I want to re-emphasise the point made by my hon. Friend the Member for Livingston (Mr. Cook). Any additional resources will be marginal in comparison with the health care budget. If we want more resources for the Health Service, they must be obtained from income tax. That is the basis on which the Health Service was set up and that is the only way in which extra resources can be obtained. We must remember that, when we refer to increased resources, we are talking about marginal increases.
I am worried about the question of selling hospital services within clause 4. I am not referring to a hamburger chain in a hospital foyer. I do not have hang-ups about that. However, I am concerned about the idea of health boards going out of their way to sell services to patients at a profit. I want to restrict this point for the moment to British nationals otherwise other considerations will have to be taken into account. The selling of services and the provision of pay beds can be achieved only at the expense of other patients within the hospital. No matter what anyone else may say, that can be achieved only at the expense of the rest of the patients within that service.
There are certain reassurances written into the Bill. It is claimed that there will be no interference with performance. I asked the Minister earlier how he would ensure that and he responded vaguely. I know how he will achieve that. The Government will issue guidelines as they did in the Social Security Act 1979. Those pious guidelines are not worth the paper they are written on. No one follows them, they are hopeless. The provisions in clause 4, in many respects, will lead to the deterioration of the service for those who are not paying. That is the only consequence of clause 4.
When the Minister replies, will she tell us, if the guidelines are issued, that the services cannot be sold if the hospital has a waiting list for that service or if a waiting list would be induced as a result of the sale? The Minister might be able to build in a mechanism to prevent some damage that might be caused.
I want to refer to some other marginal sources of finance that the Health Service might consider. Such sources of finance might stop us from introducing charges for eye inspections and dental care. There are some areas which have not been examined. The Government are so determined to cut services and so intent on flogging the service off to the private sector that they have not considered the opportunities within the Health Service.
I suggest that the Minister might consider the whole question of domiciliary visits. That service does not incur great expense, amounting to about £10 million. It has probably outlived its usefulness and is considered to be abused. Will she consider domiciliary consultations by consultants with GPs? Will she also consider merit awards? Merit awards involve about £60 million. What can be done about them? Will she also consider drug companies? Before Conservative Members jump up, I am not referring to nationalisation. I am sure that the Minister is aware that the drug companies carry out a considerable amount of research for their products within hospitals. Of necessity, that research involves patients staying in hospital longer and they always receive additional X-rays, scans, investigations and blood tests. Will the Minister consider whether the drug companies should be charged for that research on their behalf?
The only area of charging that would be acceptable is one that does not involve patients. Patients should not be involved. However, we can consider a particular area of charging. Patients may be seen privately at a private consultation and as a result they may move into a National Health Service sector hospital. Patients may also be in a private hospital, but then enter a NHS hospital because the facilities are better there. Will the Minister consider the possibility of charging that private sector hospital—not the patients—when they are moved in? Will she consider charging the organisation responsible for patients entering a NHS hospital and charging it at a rate that it would charge in a private hospital? Certainly, that charge represents more than £100 million, but it is only a marginal amount. However, that idea contains the seeds for considering other methods of raising finance.
I agree that the NHS is receiving more funds than it received in 1979, but that funding is not adequate to provide the services that are required. It is not true to say that we can never meet those requirements. The Health Service in Britain receives less in funds than any other country in Europe apart from Greece. We must find the resources for the NHS. Those resources must come from central Government and from taxation. Therefore, the Opposition will continue to fight for those resources so that we may have a better Health Service for everyone.

Dame Jill Knight: May I start by saying, wistfully, that I would like to be able to support this Bill. The Bill contains some things that are right. We have a significant number of doctors and dentists who still practise when they are well over 80 years of age—some are even over 90 years of age. There has been a degree—I do not want to mince my words—of cheating about the business of retiring and then going back to work within 24 hours. I believe that the Government are absolutely right to tackle that. I also support the idea of more education and training for professionals in primary

care. I also support the few suggestions for obtaining more money—an honest copper or two—by the commercial use of Health Service resources. Why have the Government spoilt it all by bringing in charges for tests for dentists and ophthalmic opticians?
The Secretary of State will already be well aware that he faces the united opposition of the British Dental Association, the General Dental Practitioners Association, the Royal National Institute for the Blind, the Federation of Ophthalmic and Dispensing Opticians, the British Medical Association's committee, the British College of Optometrists and the Association of Optical Practitioners. I must also tell the Minister that a significant number of our hon. Friends are anxious about the proposals in the Bill. There is no doubt that there is also a large body of concern among citizens outside the House.
Can it be that the opposition to this Bill is based either on the anger felt by the public for having to pay more money if they want to be treated or the irritation felt by the professionals over being forced into a position where they receive less money? Does human greed operate those groups as a puppeteer operates his dolls? Or is it possible that there might just be some wise, sound, even altruistic arguments against what my right hon. Friend the Secretary of State intends to do? I believe that that is the case. Both dental and ophthalmic checks keep necessary treatments down to the minimum. Such checks make cases quicker, simpler and cheaper to treat. I believe that it is turning the argument on its head to say that if people must pay for a check it will mean that things will be cheaper in the end because people will find they need treatment at an earlier stage and it will not cost anything like it would if the problem were treated later on. Surely that is what happens now. People have tests at an early stage. How can it be logical to argue that, by making a charge for checks, people will receive cheaper care? I have the greatest respect for my hon. Friend the Minister, but I find it difficult to follow that argument.
In every sense, checks are preventive medicine. Astonishingly, the Bill claims to support such medicine. Early signs of conditions that can be cured or certainly treated often appear in the eyes and the mouth before the sufferer has any idea that he has a serious medical complaint. The hon. Member for Livingston (Mr. Cook) has already told us of such a case. Indeed, this morning a young man told me about how he had gone into an opticians, quite casually, to have a test. He had some time on his hands and he suddenly thought that he had never had his eyes tested and considered the fact that both his parents wore spectacles. As a result of that test he was immediately referred to a hospital because he had signs of early heart disease. He told me that, as a result of that test, he had been saved. The hospital had been able to start treating him early and had given him diet sheets. He told me that he would not have gone in for that eye test if he had had to pay a charge of £10.
There are many examples of the importance of preventive care. Glaucoma has already been mentioned. That complaint is caused by pressure building up within the eye that eventually starts to damage the optic nerve. Often, during the early stages of that complaint the patient does not notice that something is wrong, but if that problem is not caught early the condition is irreversible. Diabetes can lead to kidney failure and, as many hon. Members will know, to blindness. Again, early detection


—provided by eye tests — is absolutely essential. I received a letter from the consultant in diabetes at University College hospital and he says:
Diabetes mellitus is the leading cause of blindness in people of working age in the UK. Treatment … is able to prevent some 60 per cent. of blindness, but the changes must be detected at an early stage.
That is an important piece of evidence.
Cancer can often be discovered by both dentists and optometrists as a result of ordinary, routine check-ups. I am sure that no one in this House needs to be told how important it is to diagnose cancer early—it is a matter of life or death. Dentists can detect anaemias and sexually transmitted diseases. That is extremely important.
Dentists are extremely worried at the proposition that checks will no longer be free. When that was mentioned earlier on in this debate there was a fairly solid outcry from my hon. Friends to the effect that dentists are worried because it affects their pockets. In fact, one letter that came to me from the memberhip officer of the General Dental Practitioners Association states:
Because of the way in which dentists' remuneration is calculated (review body—DRSG)—
I am sure that all hon. Members know about that—
a reduced demand will not and cannot reduce our average net income—charges will be amended next year to make good any deficit. I hope this alone will argue the case that I am not in any way in this argument considering my income.
That is a relevant piece of evidence.
Certainly patients are also concerned because there is a great strength of feeling—I must put this on record—that dental treatment is already extremely expensive. Many people complain about the costs of dental treatment. If people are also to be charged for examinations, I do not have the slightest doubt that the majority of people will not go for check-ups. Dentists who have contacted me have told me that, at the moment, we have a wonderful state of affairs in this country. People have better teeth now than at any time in our history. Dentists feel that that will change if the proposed regulations are agreed. They say that an increase in dental disease will cost the NHS far more in the long run—we should consider the long-term effects of the Bill.
Dentists have also said that there will be a lowering standard of general health due to neglected mouths. All this hinges on whether or not people will go for check-ups. However, the highest authorities within the dental profession assume that people will not go for those checkups. They say that, as a result, mouths will be neglected and the effect will be bacteraemia, heart disease, digestive disease and chest complaints. Indeed, one dental surgeon in my constituency came up with an entirely new suggestion. He said that it would be better to do away with free dental treatment for expectant and nursing mothers since there is not a shred of scientific evidence to suggest that the incidence of dental decay is any greater for those women. So perhaps if we are considering costs we might bear that in mind as well.
The dentist also suggested that dentists should not be given a fee for examining people who have no teeth—I was astounded to hear that dentists are given a fee for examining people who have no teeth — when those people come along for replacement dentures. He says that the fee is paid for spotting oral diseases and cancers, but that it is unnecessary to spend any time on testing because such conditions will immediately be apparent during the normal course of fitting dentures.
So if my hon. Friend is anxious to save money, there are two little suggestions by people who are in the profession.
Dentists undoubtedly see the free check-up as the cornerstone of National Health Service dentistry. They are in no doubt that people will be discouraged from visiting the dentist regularly and that the present happy situation will deteriorate. Is all this really worth it to save the sum that my hon. Friend has mentioned?
Either the Minister believes that regular check-ups are not important or he thinks that people will still go for check-ups anyway. If the former, I must tell him that all the evidence is against him. I have a feeling that he himself believes that regular check-ups are important, otherwise why is he suggesting that the Government will pay for so many people to have them? If they are not important, there is no point in paying for them anyway. If they are important, are people going to go for these checks'? People who have no money worries will probably still go and have their checks. I am not really worried about those people. I am worried about the broad, middle band of people who do not qualify for free check-ups but who nevertheless cannot possibly find £8 of £10 or whatever the fee will be. One lady tells me,
I have a small growth in the pituitary gland which, if it should grow, will jeopardise my sight—starting with the peripheral vision. I therefore have to have sight and fields-of-vision tests twice a year.
She goes on,
I am the only breadwinner in the family.
Do we really think that she could go on having those tests as often as she is supposed to if she had to pay £8 or £10 every time? This lady has a problem in making ends meet as it is.
There will be young parents who will not spend the money if, say, Johnny needs a new winter coat or Jane is growing out of her shoes. If they are faced with either paying for an eye test or buying the clothes, the children's clothes are what they will go for. Parents of young children are like that.
Elderly people a little above the limit for supplementary benefit will not go for their tests either, and they are very much at risk. Elderly people are in a special category.
There are those who must have checks frequently, possibly because of a family medical history. It is the frequency of the testing which will be a cost to them, one that they will be unable to afford.
I come now to a point to which I would particularly request a reply later in the debate. If a patient goes to a doctor in his consulting room complaining of bad headaches and the doctor tells him that he needs an eye test and can either have it from an optician and pay £10 for it or have it free at a hospital, it is obvious that the patient will go to the hospital. Hospital eye departments have been under stress for years. Already we have very serious problems fitting in the patients who need to be cared for in our hospitals. Is it really sensible to direct people to have their free test at a hospital? Or—and I ask my hon. Friend this gentle question—is it suggested that later on the payment will be extended to tests in hospitals and general practitioners as well? If so, I would really rather know it now. But if it is a half-and-half service—free when given by a doctor or in a hospital and chargeable when given by an ophthalmic optician or dental surgeon —the implications are worrying.
As regards ophthalmic opticians, I must tell my hon. Friend with as much force as I can muster that it is insulting to tell a man who has been trained for three, four or five years at a university or at an eye hospital that he should give his professional, expert services free and make his money selling frames. That is an offensive thing to say to him, that his professional expertise is worth nothing and that he must get his money by other means. It is particularly offensive when the Government themselves took away the ophthalmic opticians' customary sale of frames in the 1985 legislation. I listened very carefully to my hon. Friend this afternoon when he said that the Government had enabled people to take their prescriptions from the optician and go and buy their frames wherever they liked. That is what they do.
What we are saying is that they must give the test for nothing and will probably not even be able to sell the spectacles to the person concerned. I have no pecuniary interest in this at all but I happen to know quite a lot about it. It seems to me extraordinary to tell a trained, professional man that he must give his services free when testing a person and allow that person to go and get his glasses somewhere else— because that is what we have encouraged them to do. How will the optician pay his bills, for goodness sake? How will he pay his overheads, let alone his salary and those of his staff, his rates and his rent? We really cannot expect him to do all this for absolutely nothing.

Mr. Newton: I apologise to my hon. Friend for interrupting her, but it is important that this point be understood. Firstly, I have no intention of being offensive to anyone—I always try to avoid being offensive—and I am not telling them that they should or must give their services free; all I am saying is that it is up to them to decide how they wish to do it. Another important point: while we do not think it right that people should be in a position to say that they will only test a person's eyesight if the glasses are subsequently bought from their shop, there is nothing to stop an optician, if he makes a charge for the test, offering a discount, as others would do in comparable circumstances, if the spectacles are bought from the shop. We are anxious, however, to ensure evenhanded competition.

Dame Jill Knight: That does not really invalidate what I said.
My hon. Friend said earlier, and not only here but on another occasion, that it might well be that opticians would provide their expert professional services for nothing in the hope of being able to sell the frames. This is not an acceptable thing to say to a group of professional people. Before the 1985 Bill, successive Governments had for years expected opticians to take a low fee for doing the test and to make their money on selling the glasses. Now we are beginning to say, "Never mind a low fee—none at all" and it is up to them to decide. This is not on.
I was interested to hear my hon. Friend say that there will be encouragement to treat people, test them, in their homes. This has been going on for years. Domiciliary eye tests have been carried out by many ophthalmic opticians; they have never made money on it and look on it as a form of social service. It is very expensive to load equipment

into the car and then drive to a person's home. I do not know what fee would be suggested, but they certainly would not be able to do that except at considerable cost.

Mr. Newton: NHS tests will be paid.

Dame Jill Knight: If they are to be paid, it might be more expensive than my hon. Friend thinks at present. It is a good idea, because some people cannot get out of their home, and cannot go to an ophthalmic optician for an eye test.
I entirely agree that more money must be found for the NHS. I agree with the parts of the Bill concerned with getting more money, but I do not think that we shall solve the problems of financing the Health Service in the way described in the Bill because the demand for the services that are miraculously available now is never-ending. I am certain that we must look at new methods of financing the Health Service. When we are doing that, it might be a good thing to reflect on how willing people are to show their gratitude to and appreciation of the Health Service. The money that comes out of the Exchequer is one thing, but there are so many people in this land who are willing to put more money into the Health Service, but not so that preventive medicine is as seriously hampered as I fear it might be by the Bill.

Mrs. Rosie Barnes: As several hon. Members have said, it is particularly ironic that we are conducting this debate against the background of the presidents of three royal medical colleges calling on the Government to save the Health Service. They are not Left-wing doctors, militant nurses or even restive Conservative Back Benchers. After all, one of them is the Queen's gynaecologist. It is remarkable that they feel that they should have to say publicly:
the Government must do something to save our Health Service".
I welcome much of what the Government are trying to do in putting an increased emphasis on primary health care. For far too long, primary and preventive medicine have laboured under a Cinderella image, and their importance has not been reflected in finance and development. Although today the important matters are being brought to our attention, financing is still a major problem.
The White Paper attempts to redress the balance in terms of primary health care, but perhaps it is a matter of regret that it took some eight years to arrive. However, we are glad to see it. It is clear that resources, not just for, this area, but for the Health Service itself, are at the heart of our debate.
The Government have put up a seductive and perhaps logical argument on why we need to find savings within primary health care to pay for the improvements needed in that area, but I firmly reject the principle of charging for health care checks. First, it is clearly the belief and conviction of the people that more of the wealth currently being generated should be spent on our Health Service. We all saw in the Sunday newspapers the rumour that the Chancellor of the Exchequer is contemplating a further 2 per cent. cut in income tax. It was an interesting juxtaposition that on the same page we had the cash plea from the three royal colleges.
The National Health Service benefits all the people, and the best and proper way to finance it is through general


taxation. Survey after survey has reinforced the understanding that people are prepared to forgo tax increases to pay for the NHS.
It is nothing short of scandalous that this country spends less on health as a proportion of gross national product than our major European competitors. That figure is declining, not going up. The Parliamentary Under-Secretary of State for Health and Social Security, the hon. Member for Derbyshire, South (Mrs. Currie), stated recently that spending on the NHS would decline as a percentage of GDP over the next few years, or, as she put it, spending would "stabilise". That is at a time when spending had not been increased to meet nurses' pay awards, and health authorities are having to pay for them out of cost improvement schemes. That should be remedied before the Chancellor of the Exchequer hands out any further tax cuts. It should be addressed before we consider further the Bill's implications.
It is not possible to place a greater emphasis on primary health care or attempt to push through major reforms without providing the necessary finance. Other sections of our National Health Service are in desperate need, but if we are to make primary health care an important part of that service, we have to pay for it. Improvements in the long term will be cost effective. There will be a time lag, but primary health care and preventive medicine will have cost benefits in future. That will not happen immediately. We shall still pay high hospital costs for curing current diseases, many of which will be preventable in future if we spend that money on primary health care now.
It is a false economy to save money in that critical area. There is no better example than to compare the cost of having to care for people who develop glaucoma, cataracts, even blindness, cancer and AIDS—many of the diseases that have been mentioned today, which can be detected through simple eye or dental checks—with the cost of continuing free tests. As a result of the Bill, people will have basic check-ups less frequently than they do now.
I shall now examine some of the less contentious points in the Bill. I accept the Government's move to turn the General Practice Finance Corporation into a limited company because that will remove the financial restrictions placed on that body by its being subject to the public sector borrowing requirement. Being allowed to spend only £12 million when there is an estimated need of over £27 million is hardly the best way to ensure that the shortage of doctors' surgeries is made up.
As a Member of Parliament for an inner-city area, which much of Greenwich is, I ask the Secretary of State to ensure that there is as much flexibility as possible in the new system to make sure that general practitioners in the inner cities get the resources that they need. I have no objection in principle to raising money through the commercial means that we have heard about today, but I worry that the Secretary of State is taking such wide-ranging powers. It is clear that he is giving himself the power to direct health authorities on how that extra revenue should be raised, and it will be their duty to comply with the regulations. I should not be so worried about those powers if I thought that it would make a huge difference to the health authorities' budget, but it will not.
I also should not be so worried if I thought that hospital managers had time to devote to those schemes, but they have not. In the same month that the Government issued the White Paper, we had a report from the National Audit Office showing that there is significant unused theatre

capacity in the NHS. Surely our hospital managers would be better used in solving the problems that deal directly with patient care. I should not be so worried if I thought that Health Service managers had the expertise to implement the directives, but in many cases that is not what they have been trained to do. It is critical that they should reap the benefit financially, and not have any extra money that they raise deducted from their revenue.
Dental inspection in schools can still take place under the Bill, but it is no longer a duty, which is a great step backwards—as was the withdrawal from the commitment to the nutritional content of school dinners. We have an obligation to ensure that our children's well-being—especially children whose parents do not take them regularly to the dentist—is maintained.
I come now to the specific issue in the charging for check-ups on eyes and teeth. I oppose such charging for three reasons. First, we have always been, and still are, wholly committed to the principle of the National Health Service being free at the point of use. So, I thought, was the Secretary of State; indeed, he is on record as having said so. The introduction of charges for eyes and teeth examinations erodes that principle. What will we have to pay for next? As has already been pointed out, it is ridiculous to be able to have free examinations for any part of the body except the eyes and teeth. Perhaps we should be considering more free check-ups on the lines of those offered by private health companies, which, in the long run, will save the National Health Service money.
Secondly, charges make no sense in health or financial terms. The dental rates study group research clearly demonstrates that charging people for examinations will mean that fewer people have them. Fewer dental and sight examinations will mean less prevention and screening, which will inevitably lead to worse health. Eye disease cases will overburden the Health Service, and other non-related, but detectable, diseases will go undiagnosed until it is too late for simple and effective treatment. This lack of free check-up treatment will overburden our hospitals. GPs will refer patients to hospitals, which will have to pick up the pieces of patients who are not diagnosed as having a serious complaint until it has become very serious.
Thirdly, I challenge the charging element because it is wholly out of keeping with what the Government purport to be trying to do in the Bill. How can one call for greater emphasis on primary care on the one hand and reduce basic access to primary care measures— by charging for them—on the other?
Let us examine some of the categories of people who will be most affected by the Bill. Pensioners are, perhaps, one of the most vulnerable groups of all. About 6·5 million of our 9 million pensioners will have to pay for eye tests under the Government's proposals. Some of them may be able to afford them, but we all know that, as people get older, they worry about their financial security and future, and many of them will shy away from paying £10 if that money can be saved for basic heating bills and other weekly expenditure.
Another category comprises low-paid people, particularly parents of young children, who are not eligible for supplementary benefit or family income supplement. Such people will not come forward for check-ups. I was involved in collecting information for the Central Office of Information before becoming an hon. Member. My work illustrated the point clearly. People who are hard up will make savings first and foremost in this sort of area.


The short, simple truth is that eye tests will be missed by elderly people, who will not be screened for many of the illnesses about which we have heard today.
It has been suggested that part of the cost of an eye test can be transferred to the price of spectacles. That is not true for the many ophthalmic medical practitioners who do not sell spectacles but give of their valuable time to perform a service for their patients. There is a lack of logic in the assumption that people who are unfortunate enough to have to wear spectacles should cover the cost of eye tests for the rest of us who may want an eye test but have to wear glasses. Charging for those tests is bad; it goes against the principles of the National Health Service and of basic preventive medicine—both of which the Bill purports to endorse.
I want to draw attention to four omissions—some of which have already been mentioned. First, I want nurses to be able to prescribe. That has already been discussed, and it is not necessary for lengthy further consultations to be held before a decision is made. I also want doctors' capitation fees to be adjusted so that they are not tempted to have lists of patients that are longer than they can adequately cope with, and they can give proper consultation time to the people who come to them for attention. I suggest that capitation fees taper off above an agreed figure—somewhere above the 2,000 mark.
Thirdly, social workers should be included in primary health care teams. That is an idea of the greatest importance. We constantly hear from doctors that they are dealing with the emotional wreckage of our society, particularly in inner-city areas, where they often deal not with a health problem, but with a housing problem. Social workers in a primary team would be the ideal means of dealing with such problems.
Finally, I suggest amalgamating the family practitioner committees with the district health authorities. That would be a sensible move. At present, two potentially rival bodies operate in the same area, which does not seem sensible.
I hope that many Conservative Members will join us in defending the principle of the National Health Service—that it should be free at the point of use—by opposing the Bill.

Mr. Jerry Hayes: I am pleased to have this opportunity to welcome the main provisions of the legislation. Some of us have waited a long time for the White Paper and for parts of the Bill. It is only right and proper, as I am sure all hon. Members will agree, that we should have a Health Service based on screening and prevention, as opposed to the sickness service that we now have. It is right and proper that doctors should be given incentives, sometimes in cash, to go into the inner cities and to check the most vulnerable in our society — the under-fives and the elderly.
It is also only right and proper that people should have the chance of being able to complain about their doctor in a more relaxed way. Many hon. Members, I am sure, know of many unfortunate incidents in which incompetent family practitioner committees and skulduggerous doctors have combined to provide little justice for some of our constituents. I am therefore delighted that my right hon. and hon. Friends on the Front Bench have grasped that nettle.
It is right that we should change the dentists' contract so as to place more emphasis on prevention. All that is laudable and should be applauded by all hon. Members.
The trouble with the Bill is that it has the Treasury's fingermarks all over it. They seem to reach right up to its throat. How can we say with our hands on our hearts— despite what Opposition Members say, most Conservative Members have hearts—that the Bill really promotes preventive medicine and screening, when we shall be charging people for their first entry into the dentist's surgery and the optician's consulting room? It is difficult enough getting people into the dentist's surgery anyway without slapping a charge on them.
In the very able and eloquent winding-up speech that I expect from my hon. Friend the Minister, I know that she will quite properly trot out the old brief with the statistics about how many people will be exempted. However, it will not really cut a great deal of ice, and in the long run this will cost the Health Service a great deal more money. I am in favour of proportional charging for people who can afford to pay, but let us have it after they have had the professional advice from the optician or the dentist, and not before.
I am glad that the hon. Member for Greenwich (Mrs. Barnes) spoke about the community dental service, because I, too, am concerned about that. The community dental service presently has a duty to examine, and in some cases to treat, children's teeth. Under the Bill that duty will be turned into a power, and we all know what occurs when that happens. Health authorities that are hard-pressed for resources—in other words, most of them—will say that they have an opportunity to cut out a non-acute service. That service will be the treatment of our children's teeth. Admittedly, the British Dental Association has a vested interest in this matter, but it is right when it warns that because of this there is a very good chance that 50 per cent. of our children will not receive free dental care. That cannot be right.
On the broader matter of the Health Service, the Government have a record second to none. We know that we have more doctors and nurses and by how much in real terms we have increased Health Service resources. We know how many hip operations, heart bypass operations and other operations have taken place, and how the waiting lists have decreased. However, there is no point in all of us repeating those statistics like some sort of mantra. Every hon. Member, whatever his party, knows that most health authorities have some serious problems. Unless the Government get to grips with the general problem of financing, I suspect that there will be serious trouble.
My hon. Friend the Minister knows that I went to see her with a delegation about my own district health authority, West Essex. I do not want to bore the House with specific details or with too many statistics, but that health authority is a classic case. It is doing the things that the Government are asking authorities to do. It was the first one in the region to put personal services out to tender, and one of the first in the region to implement the Griffiths proposals. I presented to my hon. Friend a team consisting of consultants, management, nurses and the community health council, and all the members of that delegation were wholly united in their aims on cost efficiency. That is rather unusual, because very often those strands in the Health Service tend to pull against one another rather than with one another.
Sadly, we were not able to get the £600,000 that we need, despite the savings that have been made. We have even had to close a hospital, and that was a difficult political decision. It was the right decision, but it was difficult to close a hospital in order to make us more efficient. Despite all that, we will be overspent next year by £1 million, and the situation will get worse. It also means that from 11 December four acute wards will be closed. That means that 20 per cent. of acute beds will be knocked out of the West Essex district health authority, and from that date there will be only emergency surgery for the whole of the district.
What do I tell my constituents? Do I go through the figures showing how much more money we have put into the Health Service, and do I tell them about cost efficiency and about the pay awards? If I do, they will say to me, "Never mind all that. We see demoralised nurses and wards being closed, and we know that when we want to see a consultant paediatrician or an orthopaedic surgeon we will have to wait seven months for the first consultation." As a result of the cost efficiencies, or the cuts, that we have had to make, the waiting lists are increasing at the rate of 100 people a week. That cannot be right. There are swathes of inefficiency in the Health Service, and it contains incompetent management. It is right that such things should be rooted out, and the last thing that I would ask this or any Government to do is to featherbed such people. However, I suspect that just about every district will have such problems by next year.
I should like to propose one or two matters that the Government should take into account. First, doctors' and nurses' pay awards are negotiated nationally. District health authorities have no input whatever, and no matter how generous the Government properly are sometimes, they do not always phase these pay awards, and the district health authorities have to pay a large proportion of those awards on top of cost efficiencies. Next year this will probably cost us about £300,000. If the Government expect us to behave like a business—as the Bill properly expects us to do—and be efficient and cost effective, we should be treated like a business. We should not be expected to go into the market place with both hands tied behind our back. I ask the Government to consider the suggestion that the Treasury should foot the bill after the next pay round.
There is also the problem of private agencies. All hon. Members must have experience of the difficulty in prosperous areas of getting doctors and nurses. When we cannot get them on the National Health Service, we have to go to private nurses' and doctors' agencies, and they charge three to four times the usual amount. What help are we getting with that? Authorities that are efficient and taking the sort of measures that the Government have asked them to take should be favourably considered.
May we have another look at the role of the family practitioner committees? I am mystified, as was the Select Committee on Social Services, about why we had them in the first place. Very often they mirror what is done by district health authorities.
May we also have another look at the role of the regions? I am quite happy to go on record as saying that I am horrified at the way in which my own regional health authority, North East Thames, behaves. Its members are an absolute shower, and the sooner they are all given DBEs and knighthoods, and all of them packed off, the better. I do not think that a region could do any better

than have a committee of the various heads, general managers and chairmen of district health authorities, because they could make the strategic plans that are absolutely necessary.
This is a Second Reading debate and we are talking about the principles of the Bill which, apart from the exceptions that I mentioned, I support. However, I will be unable to support it further unless those controversial and very damaging measures to the health of ordinary people are removed. I fear that unless the Government abandon their plan for the charges that have been mentioned in the debate, the Bill, which could be a great landmark in health care, will be nothing but a dusty monument and a graveyard of expectations.

Mrs. Llin Golding: It cannot be denied that the Health Service is grossly under-funded. When children wait for months for necessary operations and babies die, it is clear to all caring people that more money must be put into the Health Service. What is happening to the wealth of the country that the health of its people should be of so little concern to the Government? Where is all the money going? Where is the £827 million made from the sale of BP shares, the £43 million made from the sale of British Aerospace shares, the £120 million made from the sale of shareholdings in the National Enterprise Board, the £22 million made from the sale of shares in the Suez Finance Company and the £195 million from North Sea oil licence premiums?
The Bill asks health authorities to become garage and petrol pump attendants and shopkeepers to raise money. Have the Government and the Minister no conception of the strain already put on officers of district health authorities — district general managers, treasurers and other officers—who spend long hours juggling figures and looking at changes in funding, the lack of funding for pay increases and the knock-on effects of every hard decision they have to take?
I have worked in 23 hospitals and clinics in my time in the Health Service and I have served for six years on a community health council and for four years on a district health authority. I have never known morale to be so low or known so many people to ask, "What is happening to our Health Service? Will nobody do anything to save it?" What has happened to the money from the sale of land and buildings of the New Towns Development Corporation and Commission for the New Towns, £78 million, the money from the sale of land and buildings of the Property Services Agency, £9 million, the £28 million raised from the sale of land and buildings, leases on motorway service areas, the £3 million from the sale of land of regional water authorities and the £72 million from the sale of land and buildings of the Forestry Commission? The Bill extends the provision for charging for dental and eye examinations. Does the Minister not want people to see what the Government are doing? Is there no concern for the health of people's teeth?
My niece's husband is a dental mechanic and he is very proud of that profession. If I may say so, he is 40 years old today and his wife has ordered him a birthday cake in the form of false teeth. However, it has a large red tongue sticking through the teeth; perhaps that is a comment on the charges for dental examinations. I have often spoken to him about the charges for dental health and he is deeply


concerned about the increase in his work load and that early provision should be made to prevent so many people from needing false teeth.
What has happened to the £64 million from the sale of shares of Amersham International, the £97 million from the sale of shares of Associated British Ports Holdings, the £2,703 million from the sale of shares of BT, the £1,053 million from the sale of shares of Cable and Wireless and the £107 million from the sale of oil stockpiles? I could go on, but suffice it to say that from 1979–80 to 1986–87 it is estimated that privatisation proceeds totalled £12·1 billion. With all that money having come in, the Bill restricts the amount that can be spent on some aspects of the general practitioner services. What happens if the money runs out and the need is urgent? Will sick people be told that they will have to wait until the next financial year to be ill? Where is the Tory philosophy of let the market decide; or does that not apply to sick people?
We are informed that British Steel makes a profit, so it must be sold off, for perhaps another £2 billion. Where will that money go? We can rest assured that it will not go into the Health Service to solve the problems of services to mentally handicapped or the elderly, primary care services, acute services, maternity services or all the other services so desperately in need of money. We all know that the money will go to keep people unemployed and to reduce taxes to the promised 25p in the pound, but at what cost to the health of the nation?
I remind the Minister that the Prime Minister promised that the Health Service would be safe in her hands, as well as the 25p in the pound tax. The Minister should be aware that there is real public and professional concern about hospital and community funding. The 1986 report of the Social Services Select Committee, "Public Expenditure on the Social Services", pointed out that expenditure in hospitals and community health services has been lower than in the health services. It has grown by less than 0·5 per cent. annually in real terms in the past five years. People are entitled to know how the Health Service will be funded when the Government have sold off everything that makes a profit. Will the Government have to raise taxes? Where will the money come from, and where has the money already raised gone to?
Mrs. Brown, a constituent of mine, whose small son Andrew is waiting for a heart operation at the children's hospital in Birmingham, told me yesterday that a quarter of all the beds in the hospital, which also caters for children with cancer, are empty due to lack of money, as are one third of the beds in the older children's heart ward and half of the beds in the babies' ward. She told me that only four cots in the intensive care unit were in use last week.
The Bill does not even pretend to consider the health of the nation. Everyone knows that it is expensive to keep a nation healthy and to care for the sick, but when we see the sale of major Government assets we are entitled to ask how the Government will raise the money to finance the National Health Service. Will the Minister tell the House that the Government are no longer prepared to stand by and see sick people suffer? I make no apology for ending with a special plea to the Minister: the young children who are awaiting heart surgery need our help now. Please listen to them and to the nation and please give them some hope.

Mrs. Gillian Shephard: I am delighted to have been asked to contribute to the debate because I should like to focus attention on the primary health care network, with which most people are familiar, and which is at least as concerned with health as with illness. Debates have been raging in the House and elsewhere about the undeniably dramatic confrontation between technological advance and the public purse, particularly in the acute sector of the Health Service. Meanwhile, the primary health care network continues to deal every day of the week with millions of patients. The review of the network in the Bill and in the White Paper — the first for 40 years and resulting from extensive consultation—was long overdue.
It was to be expected that the controversy, to put it mildly, about the proposed charges for those more able to pay for teeth and eye inspections would overshadow the many positive proposals in the Bill and White Paper for improving the primary care network. A rationalisation of dental charges, to make them more logical and comprehensible, has been sought by the dental profession for a long time. I do not want to make light of anything, but it is a very long time since I had a free inspection from my dentist. He may be quicker on the draw than many people, but I have always been inveigled into having cleaning, brushing or this or that when I have gone for my free inspection.
There is much concern on both sides of the Chamber about charges, particularly the eye inspection charges. They could militate against the emphasis on prevention, which is the main thrust of the White Paper and the Bill. I hope that my hon. Friend the Under-Secretary will give due emphasis to that concern and to the way in which the proposed charges can help to resource some of the other proposals in the Bill. I hope also that she will say that there will be constant monitoring of the effect of the charges.
Some interesting suggestions have been made by hon. Members on both sides of the House about how extra resources can be found for the Health Service. I remind the House of the £160 million which is wasted every year in over-prescribing drugs. That money could be used instead to run 40 geriatric wards. I hope that some attention will be paid to that.
I represent a rural constituency of 1,100 sq miles. A population of 76,000 is scattered rather unevenly throughout it. Some parts of the constituency are 20 or 30 miles from the nearest acute hospital. In those circumstances, the primary health care network assumes an importance that is not experienced by, for example, the populations of Bradford, Bromley or Greenwich.
Of key importance in rural areas is the quality of service provided by the local general practitioner and the ability and-or possibility that he has to work with other health care professionals. I was delighted to read in the Bill that there will be enhanced incentives for the improved training of doctors and other primary health care workers. Better still is the suggestion in the White Paper that there should be negotiations with the profession on special arrangements for releasing for training practitioners who work single-handed. That is a rare mention of a specifically rural problem. There may be practitioners who work single-handed in urban areas, but patients in those areas have the choice of walking to a group practice. In rural areas there may be no choice.
The White Paper concerns itself with making services more responsive to consumers' needs and giving patients the widest possible range of choice in obtaining high-quality primary care services. Family practitioner committees will be required to provide more details of qualifications, the success of the doctors and opening hours, for example. That will be helpful, but choice in rural areas will still have to be governed by geography and by the professional catchment area arrangements that are made by doctors. It is entirely reasonable that doctors should create those areas, which are based on how far they have to travel to make home visits. I hope that the information to be provided by FPCs will make entirely clear to patients the rationale for the areas so that there can be no suspicion that an element of professional solidarity may have contributed to their creation.
As nearly 50 per cent. of medical students are now women, it is not unreasonable to suggest that in the near future all patients should be able to consult a woman doctor if they wish to do so. I hope that the negotiations with the profession will take account of the fact that some patients would prefer not to be registered with a single-handed practice while others would prefer not to be with one that does not offer an appointment system. Single-handed practices and others that do not operate the appointment system are not uncommon in rural areas.
I believe that greater competition in GP services will result in enhanced services for patients in urban areas, but in rural areas, where a patient's choice may be limited to Dr. X, I question whether rewarding the doctor for the size of his list will improve his performance. Rewards should reflect excellence, and I am certain that they will in due course. They should not reflect a doctor's geographical location. I am sure that this matter will be borne in mind by my hon. Friend the Under-Secretary when she negotiates with the profession.
Sometimes the strength of a rural community, especially its close-knit nature, can, in reverse, be its weakness. A good example is complaints. Fortunately, complaints about GPs in my constituency are rare, but they can and do occur. I welcome the recognition given in the White Paper to the great difficulty that most patients would feel in making complaints about their doctor. The deference factor is still strong in areas such as mine. In some instances there is a fear—it is to be hoped that it is without justification—of reprisals or at the very least embarrassment, when there can be no question of an individual changing his doctor because of geographical considerations. I warmly welcome the improved, simplified and strengthened complaints procedure which I believe will be effected by circular.
Enhanced powers are to be given to FPCs. They and health authorities will be encouraged to collaborate more effectively. The divisions between FPCs and health authorities are utterly meaningless to patients, the average patient not knowing, and not wishing to know, that a general practitioner looks to one while the community nurse looks to the other. The patient wants care when he needs it, and he wants it to be delivered to him in a way that is professionally co-ordinated and effective. That is why emphasis is given in the White Paper to various forms of preventive work such as immunisation, vaccination and screening. That is to be welcomed, and it stems from the fact that this work is already being undertaken in a variety

of ways in the best practices throughout the country. That has been revealed by the work of the Select Committee on Social Services.
I have mentioned previously the work that is taking place in my constituency and, in the interests of being brief, I shall not go into it in detail again. In parts of the Norwich health authority there are multi-disciplinary teams of health professionals who are employed by the health authority. They work closely with doctors, or groups of doctors, to provide a complete network of primary health care. These teams include physiotherapists, clinical psychologists, occupational therapists, speech therapists and dieticians, for example. Also included in the team are health educators, social workers and voluntary co-ordinators.
Artificial divisions between FPCs and health authorities need not be relevant when there is goodwill, as in my constituency, and when the well-being of patients is at stake. It is not the pattern that is proposed in the community nursing review, but it includes several elements of it. It avoids the hazard, as perceived by some, of making all services practice-based rather than community-based. I hope that the circular that was issued last week will encourage health authorities to find their own solutions that are tailored to the needs of their communities.
I hope, too, that the intention behind paragraph 7.13 of the White Paper to give nurses more freedom to prescribe will be pursued without delay. It can only make sense in a service in which increasing demands are being made—that is agreed by both sides of the House—if all the professionals who work in it are used to the full. Nurses should not have to waste valuable time that could be spent caring for patients in obtaining prescriptions, for things such as dressings, from pharmacists and then taking them to patients. They are capable of using their own professional judgment on the timing and dosage of drugs that are prescribed by a doctor. Many professional emotions can be stirred up by the use of the term nurse-practitioner, but she exists already. She certainly exists in the mind of the patient.
I hope that my hon. Friend the Under-Secretary will note some of the matters that I have raised. I cannot emphasise enough the vital importance of primary health care networks in rural areas such as the one that I represent.

Mr. David Young: The Bill is part of the Government's overall strategy towards the National Health Service as a whole. That strategy means the imposition of financial cuts under the guise of lofty aspirations that lie behind the NHS. We should be concerned with whether the necessary resources are being made available to meet the needs of the NHS and not with exactly how much more money is being spent upon it. We have a sick service because the necessary resources have not been forthcoming, not a health service. When the required resources are not available there is much more that is adversely affected than patient care. For example, the morale suffers of those who look after the service.
We have the cheapest comprehensive Health Service in the Western world. About 6·2 per cent. of our national wealth is devoted to it, but much more is spent by other countries on their health services. We spend 50 per cent. less than Sweden, Holland, Germany and France.
My district health authority has managed to balance its books this year, but three out of five district health authorities have run into financial difficulties. However, the Bolton district health authority tells me that next year it will be unable to balance its books, although there is a legal requirement for district health authorities to do so. One of the reasons is the underfunding of pay increases by the Government. Moreover, whatever money the Government may save by this Bill will be lost by the employment of agency nurses. In the last year for which figures are available, Bolton spent £115,000 on agency nurses, and I am told by the authority that it will spend £200,000 on agency nurses in the next financial year.
The Government say that 100,000 NHS patients were treated privately last year, with the result that they came off the waiting lists. Private health service hospitals operate at a profit, but it is a parasite service because it is based on resources that are largely provided by the NHS. Private health services do not contribute a penny towards the training of the doctors and the nurses whom they poach from the NHS. My district health authority, which is a very responsible authority, says that that is intolerable. If one is seriously ill or terminally ill, it is soon made clear that private health insurance will either be offered at a prohibitive premium or that it will not be offered at all. Such patients therefore have to be treated by the NHS.
The Government are actively discouraging eyesight and dental care by literally fining those who want to have such regular eye checks. That will affect in particular young workers. The proposals will discourage them from having such checks. My constituency secretary had glaucoma, but because he had an eyesight test the condition was picked up and his eyesight was saved. Had he gone to his optician two months later, he would have lost his eyesight. My father told me that before the NHS was set up he went to Woolworths where there was a test card that he used when he tried on spectacles. He did that to save the cost of a visit to an optician. We are being dragged back by Government to practices of that kind by the terms of the Bill.
The Government argued that fluoride should be added to water to prevent tooth decay in young people, but the Bill does away with the mandatory requirement to carry out school inspections.

Mrs. Currie: Will the hon. Gentleman give way?

Mr. Young: No. The hon. Lady can deal with that point in her speech.

Mrs. Currie: Perhaps the hon. Gentleman will allow me to deal now with the point that he has made about fluoride.

Mr. Young: Very well.

Mrs. Currie: I am most grateful to the hon. Gentleman. May I remind him that included in the White Paper proposals, and also covered by what we are attempting to do in the Bill, is increased expenditure on fluoridation that will assist areas such as the hon. Gentleman's area.

Mr. Young: Is it not, then, even more necessary to carry out dental inspections in schools? I did not resent the fact that the hon. Lady was trying to intervene, but those on the Front Bench will have their own time in which to reply. I did not think that I ought to take up the time of other Back Benchers by giving way.
As for AIDS, Bolton is in receipt of a Government grant for AIDS training. Largely because of the expertise of Mr. Curtiss and his team, there are 32 HIV patients, 19 of whom are HIV positive and come from outside Bolton: four from Merseyside, 14 from Greater Manchester and one from Lancashire. However, the cost of drugs is about £14,000 a year per patient, which puts further pressure on the district health authority that is trying very hard to balance its books.
Last week I put down a question in which I asked about the cost of employing agency nurses in England and Wales. We shall run into long-term difficulties over that. Bolton is not unique; many of the difficulties that it faces are mirrored all over the country. I got the go-ahead some years ago for the building of a general hospital in Bolton. The building was delayed several times, but at last that hospital is about to be constructed. However, my district health authority tells me that it will not be able to employ sufficient nurses to run it.
In Bolton, 36 per cent. of its nurses are on part-time contracts. It is 186 whole-time equivalents below the funded establishment. The psychiatry department is short of 18 whole-time state registered nurse equivalents and it is short of eight whole-time state enrolled nurse equivalents. The cost of agency nurses in some departments is very high. That is particularly true of the elderly and the acute services. In Bolton there is a shortage of 60 whole-time equivalents for those services.
We must plan for the long-term provision of nurses. Apart from pay, status and fringe benefits are very important. Many nurses prefer to be agency nurses, not just because of the pay but because they have families to look after and can choose the hours that they work.
At the moment, 25 per cent. of student nurses are girls who have left school with four or five 0-levels. By 1995, partly because of a falling birth rate, we shall need 50 per cent. of girls with that kind of qualification. We must ensure that, apart from a good salary, nursing is looked upon as a long-term career by both men and women.
At the moment our problem is not one of recruitment, although we are running into difficulties. Our problem is wastage, and we must stem that. It is no good saying that we could bring in people from the youth training scheme, which is one of the ideas that is being considered to solve the backlog. We must make nursing a career as attractive as Marks and Spencer makes its business to its employees. That company does not deal with its employees as simply so many pairs of hands. I use that expression because it was used to me by one of the senior officers of my health authority when he was talking about what we are doing in psychiatric nursing. He said that auxiliaries were brought in simply on the basis of "pairs of hands", but that they were not experienced and trained staff who could do the job that is required. That is the battleground on which we are fighting.
Finally, the whole problem was summed up in yesterday's newspapers in which attention was drawn to the palatial premises that the Ministry will occupy at Richmond terrace. I do not know whether what was written was true, but if one compares the descriptions of the bathrooms and the chandeliers with the conditions in which the nurses in my authority work, one can see why they feel that morale is at its lowest-ever ebb. True or false, it is typical of the way in which the Health Service works. I justified the Ministry because I am not a vindictive man. I said that, like Lady Macbeth, Ministers may feel that


constant ablutions would salve their consciences. Perhaps I am mistaken but I have never thought that the Government lacked a heart. However, sometimes I wonder whether, in dealing with my constituents, that heart has been bypassed.

Mr. Churchill: There is much that I welcome in the Bill, especially those parts that are aimed at encouraging health screening and preventive medicine. Therefore, I particularly regret that I shall be unable to support the Government in the Division Lobby tonight. However, by deciding to charge for dental examinations and eye tests, which have hitherto been free, the Government will directly undermine their claimed objective of encouraging more people to go for checks. Indeed, the reverse will be the case.
I am foremost in acknowledging that no Government have done more for the funding and staffing of the National Health Service than the present Government. The Government have undertaken the greatest capital spending programme that has ever been seen in the Health Service in the post-war years. I should like to thank my right hon. and hon. Friends for the improved investment that has taken place in my Davyhulme constituency at Park hospital, where we have an excellent £5 million new geriatric unit and a £1 million coronary and intensive care unit, as well as massive improvements in community care facilities. All that is of enormous benefit to my constituents.
Opposition Members are in no position to criticise this Government's actions on health. No Government imposed such constraints on the funding of the Health Service as did the Labour Government in the late 1970s. No Government treated the nursing profession more shoddily. Therefore, we do not need any sermons from the Opposition's Front Bench, let alone their Back Benches.
The demands on the National Health Service are colossal and seemingly open-ended. In many ways, we have become the victims of our own success. It is rather like building an urban motorway into the centre of the city. No sooner is that done than one finds that more traffic has been generated and that the jams are worse than ever. A similar situation confronts us in health care today. At the moment we have 750,000 more pensioners than a decade ago. What I would describe as "new technology operations" impose an enormous cost burden on the Health Service. Hip replacements have increased 50 per cent. compared with 1978–79. Heart bypass operations take place at four times their rate in the late 1970s. Babies today have a greater chance of survival. All that is due to the expensive care, techniques and equipment that have been developed. The fact that we have a far greater throughput in the Health Service for both in and outpatients also imposes a great burden. On top of that, the cost of high technology equipment, such as scanners and lasers, is enormous and drugs certainly get no cheaper.
The revenue expenditure for the north-west area has increased from £386 million in 1978–79 to £970 million in the current year, which is an increase of 27 per cent. in real terms. That is undoubtedly a massive increase in resources. It is thanks to this Government, who have got the country's economy moving in such a way as to generate those massive resources. We should not have had those extra resources had the Labour party been occupying the Government Front Bench.
The problems of funding that confront the north-west region as a whole, and Manchester in particular, with its large number of regional specialties in its hospitals, are enormous. In the south Manchester area, which covers much of my constituency, hospitals are told that they are overspending. They are convinced that they are underfunded.
Many of our hospitals in Manchester are second to none in the calibre of their work, the skill of their staff and the efficiency of their operation. The Christie cancer centre, for example, treats twice as many patients relative to its resources as does the Royal Marsden in London. Likewise, the Manchester Royal Eye hospital is twice as efficient in its use of resources as Moorfields Eye hospital. That is all the more reason to regret the fact that we are unable to use those facilities to the full because of lack of funding. The Department recently offered us £450,000 for a new cataract day centre at the Manchester Royal Eye hospital. That would have been backed by a further £350,000 from private industry. However, we had to turn down that £800,000 package because we did not have the revenue funding to operate it. Understandably, such facts cause enormous alarm and concern. The waiting lists at the Manchester Royal Eye hospital have trebled since 1983. So far as I am concerned, that is a wholly unacceptable state of affairs.
We have been told that 220 acute medical and surgical beds at Withington and Wythenshawe hospitals in the South Manchester area health authority are threatened with closure in the coming months. Work at the excellent lung cancer unit at Wythenshawe is also under threat. I must say to my hon. Friend the Parliamentary Under-Secretary of State that those threatened closures and the threat to patient care which they imply are unacceptable to my constituents and me as their representative in Parliament. I will not stay silent while damage is done to my constituents' interests.
The wild spending of the loony Left council in Manchester has done nothing to help. The total rates bill in Greater Manchester district health authority has increased from £3·2 million in 1979–80 to £9·3 million in the current year—a £6 million increase in rates on our hospitals. It is no wonder that we shall have to close wards and get rid of nursing staff if those sorts of increases are implemented by local government. I look forward to the introduction of the community charge and the unified business rate which, I hope, will moderate those impositions on the Health Service.
My right hon. Friends have made an error of judgment on the optical and dental charges. Naturally, many people can well afford a tenner, but for many others £10 will not be an insignificant sum. Indeed, for some of my elderly constituents it represents more than 12·5 per cent. of their total weekly income. My fear and belief is that the Department will save little in cash terms and what it will save will be at the expense of the health of those who feel that they cannot afford the new charges and so neglect their health.
I fully share the anxieties expressed by my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight), who spoke so eloquently earlier, that if these charges are implemented, a significant number of people will not have those tests which give early warning of so many diseases, including glaucoma. It is wrong to charge for such examinations and I hope that in the coming weeks


my right hon. Friends on the Front Bench will reconsider this provision, which damages a Bill that in other ways is so commendable.
New sources of funding must be found urgently for the NHS. Part of the solution may be a national lottery. Why not? I would certainly have no objection to that. Part may be to encourage the expansion of private health insurance still further. Those who take out such insurance undoubtedly take an enormous burden from the shoulders of the NHS because in effect they are contributing twice to their health care — once through private insurance and once through taxes. But part of the additional resources must be found from the Exchequer. The Treasury must be told in no uncertain terms that it cannot and must not look to the NHS as a source of funding.
I plead with my right hon. Friends to be rather more imaginative and radical in their approach. Our objectives must be, not to ration demand, but to satisfy it. Under the present system that desirable position will never be obtained. I urge my right hon. Friends seriously to consider introducing the system which seems to work so well in France. There NHS patients have a choice. Yes, they have a choice. What an unthinkable idea in the British NHS! Yet in France NHS patients have the choice whether to seek treatment within an NHS hospital or from a private clinic or hospital at the expense of the NHS, providing that the private clinic's charges are within the scale approved by the health ministry. That is an important proviso. There is no extra cost to the patient.
The consequence of introducing such a freedom in Britain would be twofold: first, waiting lists would be slashed and, secondly, although in the short term the volume of operations would undoubtedly increase, in the long term there would be a reduction in the cost of individual operations. Clearly, anything that can be done by a nationalised organisation can be done far more efficiently and at less cost by the private sector. That would lead to an increase in the effective and efficient use of resources in the interests of both patients and taxpayers.
I strongly urge my right hon. Friends to examine that proposition closely. It would give greater freedom of choice to patients, while securing the most cost-effective use of NHS resources for taxpayers. Both aspects are in line with our party's philosophy. Our people are entitled to a more efficient Health Service in which they do not have to suffer the agony of queuing and in which they can get the treatment that they need when they need it.

Mr. Jimmy Wray: We are both imaginative and worried. We do not have to be members of the medical or legal profession to understand that the Bill is not about health or medicine, but is about profit and greed. Moreover, it takes the first steps towards privatising the NHS.
The meat of the Bill is in clauses 4 and 8. The Minister said that the Government had decided to increase dental charges from £115 to £150 because they had not been increased since 1985, but he did not say that since 1979 there had been more than a 350 per cent. increase. That provision should obviously be removed from the Bill.
The Minister spoke about the half billion pounds that should be spent on the Health Service, but he did not emphasise that nurses were dealing with an enormous

number of cases which they had never dealt with previously; for example, hepatitis A and B, non-hepatitis A and B and the human immuno-deficiency virus. If the Government refuse to spend money on that new problem, we shall have an AIDS epidemic on our hands. The disease is spreading, and the Greater Glasgow health board gives reports every month on the problem and the Government must take heed. Last year the BMA warned the Government that to keep the Health Service at a standstill it would need an increase of 7·8 per cent., not the 6·5 per cent. which the Government were proposing.
The Minister also said that £170 million would accrue from dental charges, which would resource some other need, but he forgot to admit that £1,700 million is needed to bring our hospitals up to acceptable standards.
The Minister spoke about cervical cancer. I am most concerned about it, as my constituency is one of the most deprived areas in Britain. A report by the Greater Glasgow health board talks about the standardised mortality ratios for previous health districts within its boundaries. The mortality rate in the Greater Glasgow health board area in the age group of 40 to 69 years is 70 per cent. higher than it is in Japan, Norway, Sweden and Switzerland. It is on places such as my constituency that we should be spending money.
I read the epitaph of somebody who had passed away from a very deprived area when I listened to the Minister speaking about the extra money that was spent on fluoridation of the public water supply. That really concerned me, because the Bill contains only one clause about medicine. I wonder whether the Minister realises just how many medical products go into the market without passing through the Committee on Safety of Medicines. Hon. Members should consider the amendments to the National Health Service Act 1946 and section 130 of the Medicines Act 1968 which defines a medicinal product. I wonder whether it will be legal for the Government to give money to every health board throughout the country to fluoridate its public water supply. Fluoride in its raw state becomes fluoroacetic acid as soon as it hits water, and I am concerned about that.
It is time that we looked at some of the medicines that are coming on to the market, and at some of the pharmaceutical companies that produce them. There is Temarcpam which is known on the streets as the yellow peril, and Librium, Valium and Pethidin are making their way on to the streets. There is also that famous drug that the doctor prescribes when patients tell him that they have had a bout of depression—Ativan—which ensures that they are depressed for life. The Committee on Safety of Medicines should consider such drugs.
The National Health Service has had crisis after crisis. We are losing 30,000 nurses a year because of low pay, as the Minister said earlier this afternoon. It is nonsense for him to say that £600 million will deal with the Health Service's problems, since £280 million was needed for the nurses' pay increase last year. There are about 668,000 people on waiting lists in England and 81,000 on waiting lists in Scotland. We must do something about that. In Scotland we have lost 750 nurses and 1,600 people who work in the National Health Service. I hope that the Government will invest more money and will realise that we need a Health Service for deprived people living in poverty who can ill afford to pay for any of those services. We know about prescription charges, which have seen a twelve fold increase since the Government came to power.


We want a Health Service that is free for all and paid for by the taxpayer, whose shoulders are best able to bear the burden.
I hope that the Minister for Health and the Under-Secretary of State will examine my constituency, where there is great poverty, where people live in squalor and where the environment is so deplorable that Prince Charles talked about it for 10 minutes on the radio. Those are the problems that the Government should try to solve, and one way of doing it would be to spend more money on the Health Service.

Mr. Chris Butler: I wish to strike a new note by talking about clause 13, and specifically the reimbursement of general practitioners for their practice expenses. I shall home in on the use of computers in general practice. Some hon. Members—perhaps many— will have invested a great deal in new technology, including computers, in their constituencies. Some hon. Members may even have used their computers. Perhaps fewer have used them effectively. I do not know how many pieces of hardware there are in constituency offices —there are probably 57 varieties or more, all doing their own thing — but the real power and dynamism of new technology comes from, to use rather trendy words, inter-operability and interactivity. The dramatic synergy that one can get from new technology comes when computers talk to each other and talk back to their users. There is a new realisation of that in Conservative central office. There is, too, in the European Community, with the INSIS programme. There may even be a realisation among the cloth caps of Walworth road—if they have not yet been made redundant.
Only two paragraphs of the White Paper that gave rise to the Bill are devoted to that important point. The White Paper believes that new technology is a good thing and it notes that
a variety of computer-based systems already exists.
That is as far as it goes, except to say that in Scotland things are rather more advanced, as they usually are.
General practitioners are ready and willing to use new technology. They are already discovering the value of new technology in their practices, in making up practice accounts and repeat prescriptions, in setting up call and recall systems for immunisation and in noting visits. But the quantum leap that they could achieve has yet to be perceived by the health authorities and by the Government simply because they are all doing their own thing. We must have some pre-planning if we want the radical change about which I am talking. I envisage a data network linking general practitioners, chemists, family practitioner committees, health authorities and hospitals. That would have great advantages in speeding the process of clinical trials, so that the process of getting approval for a drug can be telescoped. It would be of immense benefit to our pharmaceutical companies.
I envisage many other advantages. A general practitioner could discover immediately whether beds were available in the local hospital or further afield and thus make use of unused capacity in the system. That could have a dramatic effect on waiting lists. A patient visiting his doctor could go to the nearby chemist and find his prescription already made up and available simply because of the exchange of information. A general practitioner could obtain immediate information on the cost of drugs,

on their side-effects, and on their administration. Family practitioner committees and health authorities could have timely warning of the build-up of epidemics quicker than we have under the notification system. General practitioners could report much more speedily the side-effects of any drugs, and this could replace the creaking yellow card system. New technology could achieve all this and more.
But there is one condition. We must begin to move away from an ad hoc response to our problems to an overview of the position. Only the Government can do that. It is no good leaving it to general practitioners, family practitioner committees or health authorities. To obtain the overview, the Government must take the lead. They could use clause 13 to do that by reimbursing general practitioners for expenditure on equipment that is interoperable and interactive. It need not be expensive. There is a parallel with urban regeneration, where the Government have the vision and provide the pump-priming funds, and then the private sector responds and we obtain a multiplying factor of the public sector funds involved. In this case, the private sector could be the pharmaceutical companies. They would benefit from being on the inside track of such a data network. I hope that we shall make the correct choice between muddling along as we are and the quantum leap that I have described.
Of course, the debate today and all debates on the matters that I have mentioned take place against a backdrop of pressure for more resources for the NHS. The British Medical Association has asked for more. It said:
For some years now the money allocated by the Government for the service has been quite inadequate to meet the demands made upon it by the public.
That is strong stuff. That was the evidence of the BMA to the Merrison committee, which reported in 1979, after five years of Labour Government. What was the response in that report, which was commissioned by a Labour Government? It was:
Whatever the expenditure on health care, demand is likely to rise to meet and exceed it … To believe that one can satisfy the demand for health care is illusory.
A signatory of that report was the hon. Member for Cynon Valley (Mrs. Clwyd), who is not here today. This is a tightrope that Governments of all colours must tread, and it ill behoves Opposition Members to have the screaming abdabs about us when their performance was so clearly inferior to ours.

Mr. Robert N. Wareing: To keep up the latter points made by the hon. Member for Warrington, South (Mr. Butler), I think that it is a cheek for Conservative Members to try to ignore the fact that without a Labour Government after 1945 we would not be discussing a National Health Service. The establishment of the service was opposed by many Tories. Indeed, the late Sir John Anderson thought that welfare was likely to be a running sore in our economy. Conservative Members probably believe that it is a running sore in the economy now.
The Government have missed a golden opportunity when introducing this Bill. They had a marvellous opportunity to address important problems facing the National Health Service. The Bill could have encouraged recruitment of more nurses, particularly intensive care unit nurses, about whom much discussion has taken place in


recent weeks. It could have improved the position of other staff in the Health Service, such as speech therapists and medical laboratory scientific officers. It could have addressed the problem mentioned by my hon. Friend the Member for Glasgow, Provan (Mr. Wray) regarding the dangers of dry Lorezepam, still popularly known as Ativan, which is regarded as mind-bending and about which we now have ample evidence. I asked questions about that drug in October 1984, but the Government have done nothing serious to exercise adequate control over the drug and to prevent its over-prescription, which creates doctor-induced drug addiction among people.
I wish to deal mainly with the charges for eyesight testing which was not mentioned in the Tory party manifesto. Conservative Members need not fear being called to account by their local Conservative associations on the grounds that they were elected on a manifesto which embraced this idea, because it was not there. It could be argued that this is a mere detail, but I can assure the Minister for Health and his colleagues that it is not a detail to those thousands of people who, each year, require attention to their eyesight. The Government have committed yet another fraud against the electorate by introducing this measure. They would not have introduced it just before June 1987. They had every opportunity, but they did not introduce it then. I shall refer to the time when they had the opportunity to do so.
The Government set great store by competition. Free market forces and competition are the gods worshipped by the present Administration. In the White Paper the Minister for Health said that the reason for abolishing free eyesight testing was that
The Government had decided …to extend the principle of increased competition to sight testing".
The Minister argued that we should be discussing whether or not that charge will deter people from visiting an optician for a consultation and an eye test. The report of the Select Committee on Social Services, which took the evidence of the General Optical Council, stated:
The evidence we have received has not been so ebullient. The BMA is worried by the lack of reference to Ophthalmic Medical Practitioners' (OMPs) invaluable support service to hospital ophthalmology departments, reflecting the opinion of their Ophthalmic Group Committee that OMPs are 'a sadly underused and undervalued resource in primary health care'.
The important section states:
The General Optical Council are keen to draw a distinction between a full eye-examination and a sight-test. The former would pick up many defects and abnormalities which a simple sight-test would not be able to detect, enabling the optician to prescribe corrective or ameliorative treatment. Thus waiting lists are kept down in hospital ophthamology departments, and the examination can also be used to monitor diabetes and screen for glaucoma. The GOC claim that there is a growing trend towards the quick eye test as a result of commercial pressure on registered opticians and the employment of unqualified sight testers by unregistered sellers of spectacles.
I would argue that that is precisely the kind of scenario that we shall see on a much larger scale if charges are introduced. The Minister for Health in his speech in the House on 25 November referred to the fact that opticians can still provide a free test. However, there seems to be a difference in attracting custom to an optician by providing

a free test or by issuing free stamps. Commercial profit is uppermost in the Minister's mind, not the better health of the people. He is applying a commercial criterion.
Of course, an optician can offer a free test and hope that the person being tested will come along as a patient and purchase spectacles from the optician. We could almost call this a loss leader. The optician may make a loss on the sight test, and hope to gain through the sale of spectacles. What is really uppermost in the Minister's mind? Is he primarily concerned with commercial profit or people's health?
Again on 25 November, the Minister referred to the need to secure additional resources for development
by asking those who can afford it to pay for sight tests and to meet somewhat more of the overall cost of dental care." —[Official Report, 25 November 1987; Vol. 123, c. 260.]
He referred to NHS sight tests remaining free for children and certain others on low incomes. He has not adequately answered the question from the hon. Member for Langbaurgh (Mr. Holt) who asked how low an income would be before tests were free. Will the exemption be confined only to those who qualify for income support? In the opinion of most of us, many people of meagre means would qualify for free treatment.
All that is intended to save a mere £170 million. Of course that is cheese-paring, but that is all of a piece with other Government legislation. The same thing is happening in the Social Security Bill in regard to the decision to reverse the Moran judgment on attendance allowance. That will save precious little, but it all adds up to enable the Chancellor of the Exchequer to meet the promised tax cuts for richer people come next April.
There can be no justification in denying a free eye test to poor people simply to help those who can well afford to pay more in tax. We are always told that the Government want those who can well afford it to pay for this and to pay for that. They can pay higher taxes and the Government have the option next April to ensure that public opinion in this country, which is overwhelmingly in favour of maintaining our National Health Service free at the point of treatment, is unchanged.
The stance of the Secretary of State for Social Services is different from the stance adopted by some Tory Ministers in the past. The present Minister for Health was a member for Standing Committee A which considered the Health and Social Security Bill in 1984. The Committee was responsible for going clause by clause through the Bill. The Minister may well recall that his right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), one of his predecessors as Minister for Health, stated when the Government were scrapping free NHS spectacles for most people:
It is the health of people that we are, above all, prepared to, and must, protect. The desire to protect the health of individuals is the only legitimate interest of Government in what otherwise is a free transaction between the optician on the one hand and the client on the other".
The right hon. Gentleman was talking about free eye tests. The Minister went on to say:
We have continued to provide, under the NHS"—
and I want to emphasise this—
the most important service, an eye test available to everyone free of charge."—[Official Report, Standing Committee A, 24 January 1984; c. 13.]
On 26 January the right hon. and learned Member for Rushcliffe returned to this point:
We have retained all the essential requirements that we think that the public need—in particular"—


and I emphasise this again—
the free eye test for everyone and the legal prohibition on anyone selling glasses unless there has been a recent eye test,". —[Official Report, Standing Committee A,January 1984; c. 53.]
What has changed between January 1984 and December 1987? Should it not be fundamental to health that people should have the chance of a free eye test?
The Minister for Health has argued that the eye test will not cost all that much and he cited a figure of £10. Indeed, he has said that it might be less. Who knows? Who can say? After all, the Minister also said, when challenged by my hon. Friend the Member for Livingston (Mr. Cook), that opticians can charge any price. The Government will not put a maximum price on the tests. There will not be a ceiling. The sky could be the limit. There will be no Government control because they believe in market forces. Market forces means the free play of demand and supply. The price is at the point of equilibrium, not at the maximum amount of demand.
In other words, some people will not be able to afford the price. The Minister for Health may not believe me, but not everyone carries the price of a particular type of medical service in their heads. Many people would not be able to tell us the price of a prescription. After all, prescription charges have gone up about 20 times under this Government, so people can hardly be blamed if they cannot remember the price of a prescription. That charge may be £5, £10 or whatever, but many people, knowing that they will have to put their hands in their pockets—very often there will be little in those pockets—will be deterred simply because they know they will have to pay a sum of money for the test and follow that up by paying for the spectacles. Not everyone is a civil servant from the Department of Health and Social Security capable of carrying statistics around in their heads. Ordinary people do not act in that way.
The result of the proposed changes will be that far more people will be put off going for treatment. The Bill will not necessarily mean that public expenditure will be reduced. Many people who would go for a free sight test today and who would perhaps be the one person in 20 who, after that test, is referred for medical treatment will miss such medical treatment at that time. The result will be that they will be pressed into eye hospitals or into the eye departments of general hospitals at a later stage. There will be a knock-on effect and waiting lists, already high for many conditions in many places, will increase. The result will be more public expenditure and not less. It is not a pun to say that, in terms of public expenditure and patient care, this measure is short-sighted. In terms of savings it is likely to be counter-productive.
The police tell us that many driving accidents are due to bad vision. Such people are in need of eye tests and should go often to have their eyes tested. However, even under the present system of free examinations, they have failed to go for such tests and, as a result, have caused accidents on the road. I suggest that there will be more road accidents as a result of people not having those examinations because they are no longer free.
This is not the first time the Conservative Government have come forward with proposals to introduce charges for eye testing. It was proposed in a new clause presented by the Government when we were considering the Health Services Bill in 1980. At that time, the then Minister for Health, the hon. Member for Reading, East (Sir G.

Vaughan), withdrew that clause because there was considerable pressure from both sides of the Chamber and from outside of the Chamber. It would be rather interesting to know—perhaps the Minister for Health or the Parliamentary Under-Secretary will be able to tell us — how many letters have been received since 25 November when the Minister announced the proposed charge. How many letters of support has he received? How many letters opposed that measure? I suggest that he has had none from the medical profession supporting the proposed charge. However, if I am wrong I should be interested to hear.
In 1984 when the Minister and myself served on the Standing Committee to consider the Health and Social Security Bill my hon. Friends argued that the Oglesby report was likely to be the basis for Government health policy in the near future. That report advocated all sorts of charges for people who may be attending hospital, attending the doctor and so on. At that time we were told that the Government had no intention of implementing that report. However, in 1979, when the Conservative party took office, a document was published by the Adam Smith Institute that said that patients should pay for their spectacles, for the eye tests, dentures, dental examinations, for attendance by a general practitioner, and should pay to be in hospital. All those things were advocated by the institute. I suggest that the people likely to be in favour of the present Bill are perhaps the crackpots of the Monday Club and also members of the Adam Smith Institute. Certainly most ordinary, decent people are not in favour of this Bill.
The Bill appears to be the thin edge of an extremely dangerous wedge. Unless certain political events take place as a result of public action—by-election defeats or the defeat of Conservative candidates in local elections—I foresee the day, before the next general election, when the Government will introduce charges for attendance at hospital and for attending the GP. They will get us back to where they really want us to be, in the days before the NHS.
I hope that the Minister can prove me wrong. I hope that he will join with all in this House who have expressed their reservations about this proposal and do as his predecessor did in 1980: withdraw the clause from the Bill. I promise him that the Labour party, and, I suspect, one or two others elsewhere, will fight this clause every bit of the way and publicise what takes place in Committee after the Bill has unfortunately been read a Second time. I can only hope that there are people with guts on the Conservative Benches who will see that the Bill does not reach Committee. However, experience tells me that I am expecting far too much.

Mr. David Heathcoat-Amory: The hon. Member for Liverpool, West Derby (Mr. Wareing) has predicted a disaster if the charges for eye tests — he concentrated on those, but I assume he also means the charges for dental checks — are introduced. Such predictions are based on the assumption — he did not spell it out in great detail—that the charges will act as a massive deterrent to patients seeking eye tests and dental examinations.
All the evidence that we have shows that when charges are introduced or increased there is a check or even a temporary reduction in the number of patients seeking


such examinations or treatment, but soon the position recovers and the upward trend is resumed. The hon. Member for West Derby will know that from the experience of his own party. In 1951 the Labour party introduced charges for false teeth and spectacles. Ever since then, every Labour Government have found it necessary to increase charges to patients of one sort or another. If the hon. Gentleman considers the history of his party, he will discover that, yes, there is a temporary falloff, but the trend generally recovers. I am certainly confident that after the Bill has been enacted and the charges have been in operation for a short time he will find that the number of people seeking eye tests and dental examinations will resume an upward trend. The numbers will certainly remain very much higher than they were eight or nine years ago when his party was last in office.
Charges for these examinations are wholly right against a background of constantly increasing expenditure on the Health Service in general and on primary health care in particular. As the Green Paper made clear, we are set to see a further substantial rise of about 11 per cent. in real terms over the next three years. This money must come from somewhere. Three sources can be identified: first, from internal economies; secondly, and overwhelmingly, from the public sector by way of the taxpayer; and, thirdly, but significantly, from private sources by way of patient charges. People who can afford it should contribute directly towards their health care. I have noticed that very often the most vociferous critics of this principle turn out to be those who are now better off than ever before, whose wages and salaries have risen in real terms over the past few years and who have seen substantial reductions in their income tax.
I have always supported the concept that people should be allowed to retain more of their own money, but the other side of that coin is that we should, and have a right to, expect those people to provide more of the health care and security of themselves and their families. People whose standard of living has risen and whose disposable income has gone up should contribute towards this very substantial increase in expenditure on the National Health Service, the increase that we have seen in recent years and the increase that is planned for the future.
Charges also involve the patients more closely in the efficiency and value for money of the Health Service. What we pay for, we value. Any service — and the Health Service is no exception—is likely to improve if lots of people using it also contribute directly to it out of their own pockets. They form an on-the-spot audit every day of the week of the effectiveness and efficiency of the service that they are getting. If we really want a responsive and patient-directed Health Service, charges such as are outlined in the Bill have a part to play.
Let me strike a note of caution, however, on costs because clauses 12 and 13 of the Bill open the door to some increases in staff. Family practitioner committees will have additional powers to pay for training and education of primary health care staff and also directly to reimburse additional categories of staff — interpreters, computer operators and so on. I have no doubt that these offers will be taken up enthusiastically by general practitioners, and I am sure that most of the staff will be properly employed; but this could quite easily become another engine of expenditure unless we find offsetting economies. Here I

identify a very large area of potential waste which the White Paper discussed but about which the Bill is comparatively silent, wastage in pharmaceuticals.
Some doctors still have extravagant prescribing habits. It is conservatively estimated that as a nation we throw away about £160 million worth of drugs a year. The nation's pill cabinets are groaning with pills and medicines which have been prescribed but which are surplus to requirements. Some doctors—and they are not wholly to blame themselves—prescribe two, three or even more months' supply at once. It is not just financially wasteful; it is also unsafe because when the treatment ends or is changed or when the patient dies or whatever it may be, those pills remain in circulation to become muddled up with other pills or out of date, swilling around in the nation's bathrooms and pill cabinets. I would like to go for a 28-day mandatory limit for the supply of pharmaceut-icals—

Mrs. Margaret Bekett: I thank the hon. Gentleman for giving way. He has spoken very much as someone who has never had to worry about the cost of anything in his life, but he is clearly unaware that many doctors now prescribe larger amounts because so many patients can ill-afford to pay prescription charges; as pharmacists can testify, even in these circumstances many prescriptions are not fully filled.

Mr. Heathcoat-Amory: The hon. Lady flatters me—I must look more prosperous than I really am. What she says does not invalidate the point that I make because, as she should know, there are many exemptions from prescription charges, and anyone who is genuinely unable to pay them is exempt. I agree that I am not one of those people.

Mrs. Beckett: Rubbish.

Mr. Heathcoat-Amory: Moreover, what she says does not invalidate my point that we are not just financially profligate but we also endanger patients' health by doing it. Some say that we should go for generic substitution. The White Paper skirts around that. I am attracted to it and have always felt that if pharmaceutical companies need a longer period for paying back their massive investment in new drugs the patent period should be extended. Instead, the White Paper draws attention to the problem and points to a greater role for family practitioner committees.
There still remains, however, a confusion between the regional medical services of the Department of Health and Social Security, which, by and large, hold the information on their computers, and the family practitioner committees which hold the contracts with the doctors. The two should be brought together, and the FPCs should have not just the information but the duty, the responsibility and the power to follow up and take action against that minority of doctors who are unsafe and extravagant in their prescribing habits, because the potential saving here dwarfs anything else disccussed in the White Paper, and there are these additional health benefits.
I approve of the overall tone of the Bill. Prevention is certainly better than cure. In passing, I hope that my right hon. and hon. Friends on the Front Bench do not forget the libertarian tradition in our party, to which I subscribe, which says that responsible adults, if given the right information, are capable of making their own choices. That includes the right to make their own mistakes.
Of course, it must be right to point out to people incontrovertible links between, for example, smoking and lung cancer; but I hope that we do not go way beyond that and adopt a hectoring and disapproving attitude towards things which medical fashion may from time to time decree are excessively unhealthy. A balance must be struck. Let us not have too many bans and prohibitions. Let us instead rely on persuasion and education.
The Bill introduces provision for additional medical training of ancillary staff, but there is a bigger training challenge ahead. Increasingly, medical technology is pushing back the frontiers of what is possible, on the one hand, but, on the other, we know that resources are limited and that doctors are in consequence being forced all the time into making implicit judgments when having to allocate priorities. That would remain true even if we doubled expenditure on the NHS. It would be possible to design an NHS that would bankrupt the country, but patients could still be found who could claim legitimately that they were being denied a course of treatment, a wonder drug, an operation or a bit of machinery that they heard or read about and was available in some country.
Therefore, it is inescapable that choices must be made. We must try to maximise the health and happiness of patients with the resources available, which, by definition, are always limited. We must make difficult cost-benefit calculations. My point is that administrators alone are not capable of making them. We must train doctors and other medical staff so that they appreciate the problems involved and share the management burden.
I welcome the Bill and believe that it can be a springboard, so that we can face the challenges ahead, to guide us not just towards a more expensive Health Service — that would be easy — but, much more difficult, towards a better Health Service.

Mr. Dennis Turner: When I listen to the hon. Member for Wells (Mr. Heathcoat-Amory), I wonder whether he perceives that today there are people who are not enjoying an increased standard of living and whose disposable income is not gaining appreciably. Millions of people find the day-to-day and week-to-week grind to maintain and build up standards for their families a real problem.
The hon. Gentleman said that people might temporarily become consumer resistant, but that things will start to level out. Let me tell him what the first test will be when a mother with children is confronted with having to pay the £10 charge, or when a husband who is working out the week's expenditure finds that there is no £10 left at the end of the week for a dental or eye test. Those people will decide their priorities and, as a result of the charges, might neglect to do what is suggested by the Government and not go for a test. If they do not go for a test, their health may deteriorate and give rise to additional costs on the NHS. I suggest that the charges will prevent many people from taking the course that we know is in their best interests and, in the long term, of the NHS.
The Bill cannot in any way inspire confidence in the claim that the NHS is safe in the hands of the Conservative party. Indeed, it does just the opposite. As has been said by many hon. Members, great opportunities have been missed which could have been taken in the Bill.
The great arguments on the major issues involved in the NHS were effectively dealt with and the myth demolished

in our debate on 26 November. The arguments were demolished equally by my hon. Friend the Member for Livingston (Mr. Cook) and by the right hon. Member for Brentford and Isleworth (Sir B. Hayhoe), who showed clearly what has happened over the past few years to our Health Service and where the myths have arisen, and we shall hear them again tonight. We know that all is not well with our NHS.
I am privileged to represent Wolverhampton, South-East. The Parliamentary Under-Secretary for Health and Social Security, the hon. Member for Derbyshire, South (Mrs. Currie), said a few days ago that the Black Country had "nothing to moan about." At the moment in the Black Country, in Wolverhampton, Birmingham and throughout the west midlands, as the Minister knows, there is a mounting crisis in the NHS. It is not doing that word an injustice to say that it is a crisis. Over the past few months, in my district health authority, three people have died. They lost their lives because they could not be admitted to any of the hospitals in my area, when they were in a serious health condition. Over the past 12 months, 400 people who were seriously ill have had to be refused admission. They were turned away because no beds were available.
In all our acute bed specialties, with the exception of ophthalmic, there are bed shortages, and in some the figure is the equivalent of 50 per cent. General practitioners in Wolverhampton tell me that the heartache and ordeal of picking up the telephone at 5 o'clock at night to try to find a bed for a seriously ill patient is distressing. General practitioners spend hours trying to find a bed.
We have a renal unit, where the machines are provided by the community. Trade unions and voluntary bodies raised funds, doing it in the way that the Conservative party says it likes it to be done. The funds have all been made available externally. However, the unit is housed in small, makeshift accommodation. We were promised capital expenditure to provide proper accommodation in the near future. Each time that we have asked about that, our request has been turned down. We understand that the Secretary of State has said in the past fortnight that he will reconsider that, but we all know that reconsideration may not mean that that provision will be made.
When I look at my district health authority and listen to the arguments of Conservative Members tonight, a clear message comes through. There is a standard pattern of delivery by Conservative Members. First, quite rightly and defensively, they say, "We appreciate all that the Government have done to assist the Health Service. They have done a marvellous job." They duly give a pat on the back to all and sundry. However, in the second phase of their delivery they say, "But in my constituency I shall stand up and describe all the inadequacies of the service. I shall articulate the needs of our patients, doctors, nurses and the service in general. In that context, the Government are not doing a very good job at all." That is said in enough constituencies to make the Secretary of State and the Under-Secretary a little concerned about the vibes on the state of the Health Service that are genuinely coming from their own Back Benchers.
I believe that for some Conservative Members the Bill is the final straw that will prevent them from going into the Lobby and voting with the Government. That is another sign of how bad we all know the position to be under the surface. It is no good saying that a certain amount of money has been injected, when we know about


the serious day-to-day problems. I have given instances of those from my own community in Wolverhampton. Our community health council, our medical practitioners committee and my district health authority all tell me of their bad day-to-day experiences, and they are joined by the chairman of the West Midlands regional health authority in saying that there is a need for greater resources to be injected into the National Health Service, in the west midlands and throughout Britain.
It was clear from our debate on 26 November—it will be so in future debates — that the people of this country regard the situation more in sorrow than in anger. However, I give a warning: one can see that sorrow welling up in our communities and turning to anger. Sensitive men and women are identifying as insensitive a Government who fail to respond to the unassailable case that has been presented. Many Conservative Members should vote against the Bill. Let us provide the resources that are needed to start building a better Health Service for all our people. After all, is it not the test of a civilised society to move forward, rather than to introduce legislation that takes us back?

Mr. John Greenway: I am grateful for the opportunity to contribute to the debate. For the past 15 years it has been my privilege and pleasure to advise members of the dental profession on the financial arrangements and management of their practices. That experience has given me a unique insight into their way of life and the way in which their affairs are financed. I hope to share that insight in a helpful way with hon. Members this evening, as we address the difficult problem of our National Health Service.
The Bill must be seen in the context of recent trends, especially in dental health. Since 1978–79 there has been a 20 per cent. increase in the number of dental practitioners and a corresponding 20 per cent. increase in the number of courses of dental treatment. There has also been strong evidence of improving dental health, to which the work carried out by general dental practitioners has contributed admirably. However, the need for change in the general dental services has become more and more obvious.
Looking back over the past 15 years, one can see that patterns of treatment and dental care have changed dramatically. The need for change was initially reflected in the Government's Green Paper and admirably dealt with in the British Dental Association's response —"Opportunity for Change"—and was further addressed in the White Paper proposals. There is also a continuing dialogue between the British Dental Association, and its general dental service committee and the Department of Health and Social Security on the need for a new dental contract, with which I shall deal later.
We should also reflect on the fact that the need for increased resources for the Health Service and the requirement for increased charges have obscured —indeed, eclipsed—the many good things that the White Paper contains and that I greatly welcome. Nevertheless, it must be said that the announcement earlier by my hon. Friend the Minister for Health that the proportional charge that we will introduce will be as high as 75 per cent. will be a grave disappointment to many dentists. Equally, I am sure that there will be some relief at my hon. Friend's

announcement that there will be a ceiling of £150 on the total amount payable. A real fear has been expressed throughout the debate by hon. Members on both sides, that removing the free examination will lead to reduced attendances. I have some sympathy with that point of view, but the issue that must be addressed—it has not been tackled so far in the debate — is what dissuades patients from attending dental practices more regularly.
A study is now being done jointly by the Department and the British Dental Association into "Barriers to Dental Health Care". When that report is published, I suggest that there will be several possible explanations in it of why there is not more regular dental attendance. Cost is one; fear of pain is another; the possibility that people cannot find a dentist who is prepared to treat them on the National Health Service is a third. But I suggest that perhaps the greatest reason for non-attendance is lethargy. There is no perceived need to see a dentist. It will be interesting to see what the report has to say about the image of dentists and dental practices.
Much has been said in the debate about costs and charges, but the fact remains that almost half the population do not attend a dentist regularly in spite of, not because of, the free dental examination. I venture to suggest that it would be interesting if my hon. Friend the Parliamentary-Secretary of State looked into what proportion of the population do not attend regularly, and, of those, how many would be entitled not only to a free examination but to free dental treatment on remission if they went more regularly. More regular dental attendance takes place in the southern half of Britain, where the vast majority of adult patients pay a substantial proportion of the cost of their treatment. So, while it would be easy for me to stand here and say, on behalf of all my friends in the dental profession, that I could not possibly support the idea of phasing out the free examination, that is not my conclusion.
There are two reasons why I say that. First, the proportional charge is lower as a result of the phasing-out of the free examinations. My hon. Friend the Minister for Health accurately elucidated the fact that patients who attend dental practitioners the most regularly will pay slightly less under the proposed arrangements. The message must be got across to the public that if they attend their dentists regularly and keep in contact with them they will be spared large bills for dental treatment.
The second point is that it provides an opportunity for us to concentrate more on prevention. More and more patients when they go to a dental practitioner regularly need less and less treatment. Where did my hon. Friend the Minister for Health first encounter the phrase about a continuing care contract that he used in his speech? That phrase is very much on the lips of many dental practitioners. The general dental service committee has proposed to the Department that there should be a change from the present contractual arrangement and a much greater obligation placed on the relationship between the dentist and his patient by way of a continuing care contract. A proposal has been made for an annual registration fee. This annual arrangement would, one presumes, require funding at a much higher level than the present examination fee of £3·90.
One interesting point arising from the debate is that there are a great number of requirements, and of possible illnesses and diseases, for which the dentist looks when he is examining a patient. Has any hon. Member thought that


what we should be addressing is not whether we should ask patients who can afford to do so to contribute towards the cost of treatment, but whether we should ask what is a proper amount to pay a dental practitioner for the work that he does in screening and monitoring dental health? That is the purpose behind the proposal for an annual registration contract. Much research has still to be done about this, but that is the framework within which we can promote much more prevention in dental practice. Dentists have the opportunity and a great obligation to teach their patients more about oral health and about how they can preserve their teeth.

Mr. Ronnie Campbell: The hon. Gentleman glibly talks about working people paying. In my constiteuncy in the north-east, unemployment is about 20 per cent. and people are living on the breadline, or, as we call it, in the halfway house. They are frightened to go to dentists in case they receive treatment that will cost about £30 or £40. The Government are proposing to promote some sort of advertising campaign to advise people caught in the poverty trap, not only in the northeast, but all over the country. The hon. Gentleman says that he has the answer, but so far he has not told us what it is.

Mr. Greenway: The hon. Gentleman has answered his own question. We want to encourage people to attend dental practitioners more regularly so that they can avoid the £40 bills. Much of the hysteria that we have heard in the debate will not encourage people to go to their dentists because they think that they will have massive bills. That will not he the case if they go regularly, and it is not the case now.
No costing has been proposed for the annual registration contract, but one assumes that the arrangement would take care of all the screening procedures, X-rays, and possibly even the cleaning of teeth. It would be unrealistic in the present climate, given the need of the Health Service for resources, to expect that the patient should not contribute to that contract. There is an opportunity here for us to do a great deal of good to encourage patients to go to a dentist more regularly.
I shall now deal with the timetable. My hon. Friend the Minister for Health said that the Government hope to introduce a proportional charge arrangement in April, with fixed fees for those items that require primary legislation. He said that he would seek to introduce the proportional charge for the examination at a later stage. Will he seriously consider the possibility of bringing in a new contract for a continuing care arrangement at the same time as the proportional charge for the inspection is introduced? That would allow people an opportunity to absorb the major change of emphasis and would allow the positive proposals in the White Paper on dental health promotion to take effect.
I was delighted, and I am sure that members of the dental profession will have been delighted, to hear the Minister say that he is proposing to undertake a major advertising campaign for dental awareness. That is the great priority, because we must increase the priority that the public give to dentistry and dental health. Attitudes must be changed, and I warmly welcome the Government's commitment to promote health education. This must be pursued with vigour and if the funds raised from charges can be used to this effect the money will be well spent.
There are many other aspects of the Government's proposals, especially those in the White Paper, that deserve warm support. Extra resources for fluoridation will contribute greatly to preventive policy. More post graduate and vocational training will also help. It has been my privilege to be involved in dental vocational training for 10 years since the Guildford experiment started in 1977. There is a need for that, and for more resources to be devoted to it, and I welcome the Government's commitment to provide them.
We must also review the best means of achieving a more even distribution of dentists. I support the proposal in the White Paper that this should be done, and the review should consider how to make available information to help dentists decide where, when and how to invest in practice projects. We need information about local problems to be available nationally in order to encourage redistribution in a controlled way, so that local practitioners already in-place are not unduly and adversely affected.
The constitution of the General Practice Finance Corporation is also being changed by the Bill. The Government should consider whether to take the opportunity to include dental practitioners in the provision of finance for the newly constituted body.
I know that I have touched only on matters affecting dental practice. The Government's plans for family doctors and health promotion generally offer a better deal for patients and greater opportunities for doctors to improve and widen the scope of the health care that they provide. The Government's plans represent, not just a radical shake-up of the family practitioner services, but a long-awaited and much-needed opportunity to create a system of primary health care that the nation will need, not just in the 1990s, but into the next century.
It is outrageous hypocrisy for the Opposition to say that the Government are not doing enough for our Health Service and then to refuse to support the imaginative initiatives that are contained in the White Paper.
Finally, I pose one question: what sort of National Health Service will we have in 20 years? Some hon. Members who have just come to the House may be fortunate enough to be returned in future elections, and some of us may have a long and distinguished career. I shall tell the House what sort of National Health Service we will have in 20 years. Unless we pursue a policy of encouraging prevention, and unless we educate the public to the effect that they can avoid preventable illnesses, we will not be able to afford a National Health Service beyond the year 2000.

Mr. Ronnie Campbell: We will not have one if the Conservatives are in power.

Mr. Ronnie Fearn: We agree with and welcome some proposals in the Health and Medicines Bill and the White Paper. However, like many hon. Members, for all the reasons cited in the debate, we are totally opposed to the introduction of charges for dental checks and eye tests. The proposed changes make a mockery of the Government's announced intention to improve preventive health care. The proposals were not part of the consultative discussions and document and will prove to be more expensive to the NHS in the long run. Diseases and illness previously detected by opticians and dentists


will remain undetected and in the long run patients will go into hospitals, thus increasing hospital waiting lists. I quote from the document "Primary Health Care: An Agenda for Discussion", in April 1986. At page 32, under item 4, "NHS Services", it says:
Free NHS sight-tests and prescriptions are maintained for everyone who needs them. The sight-test can identify health problems as well as a need for spectacles, so it is important that skilled sight-testing should remain readily available.
We shall not have that when the Bill goes through.
We are concerned also about the removal of the duty placed upon the Secretary of State to provide dental checks and treatment, where necessary, to schoolchildren. We are even more concerned from our reading of the relevant legislation that the Secretary of State's discretionary power to provide those services extends only to children in schools maintained by local government. If the Education Reform Bill becomes law, children in schools that have opted out will be left without a safety net. Is that what the Government intend, or is it a drafting error? I hope it is the latter, but perhaps the Minister will clarify the point.
Like much enabling legislation, the Bill leaves many questions unanswered. The proposal to privatise the General Practice Finance Corporation did not form part of the consultation process. The Government obviously envisage some problems with loans being provided in deprived areas. Do they see other problems arising from the constraints of finance and commerce? For instance, will young single or married women doctors be seen as a good financial or business risk? How do the Government intend to monitor the distribution or refusal of loans? Are there plans to require reports to safeguard against maladministration? We must have more details before we can approve the proposal.
Whether one agrees with the principle of the controversial clause 4, in practice it is not as easy as it looks. It will create administrative and managerial headaches and will add to the overheads and costs, with a corresponding reduction in the income generated. Most importantly, do the Government guarantee that any extra income from those activities will not be offset against allocations by the DHSS? Unless the proposals generate genuine extra cash, they should not be implemented. Does the Minister realise that the subsections of this clause that give him the power to issue directives cover bodies such as the community health councils, and that this may go against the spirit surrounding the setting up of those bodies?
Much has been said against the introduction of cash limits on family practitioner committees, and we add our voice to those concerns. The Bill does not tell us how they are to be allocated. The House should be aware that such limits could be extended to cover all services provided by family practitioners. We know that funds for training are to be cash-limited, but we do not know what form the training must take before it will qualify for reimbursement. That is important. The training should be of a high standard and should have some uniformity.
We support some of the Government's proposals, but some should be removed from the Bill and others require far more investigation. My major worry relates to the Government's real objective behind the Bill and the White Paper. Is it the beginning of the slippery slope to the

reduction of family practitioner services supplied by the NHS in favour of some form of privatisation of the services, an objective that they hope to realise without the true and real consultation to which the electorate has a right? I fear that it is the beginning of the end to a truly national health service, which at one time was for all the people, but as we look at it now will not be for all the people.

Mr. John Redwood: I had hoped that in the debate we might have gone beyond the normal exchanges across the Floor of the House, with the Opposition saying that if only there were more money and people it would be all right, and our saying that there are many more people and more money so it must be fine. I should have thought that if Opposition Members believed that only more money and more people were required, they would admit that the hospital and GP services are much better now than they were under the Labour Government, because there is self-evidently much more money and many more people. I should also have thought that they would not turn down any suggestions or good ideas for raising money and bringing more resources into the service, which is exactly what the Bill and White Paper suggest: yet more resources for the service to meet growing patient demands.
Why is it that with all the extra resources there is still unhappiness and patient demands are not being met? Part of the problem lies in the structure of the very large, top-heavy Health Service that we inherited and are living with. The layers of management are legion. Why do we have one group of civil servants at the centre arguing with another group who run the National Heath Service management board? Could there not be unity and a single organisation? Why do we need over £100 million of regional administrative structures and inter-regional co-ordinators to carry the word down and up from the region to the centre? Why have another level of bureaucracy and administration at the district level before getting to the people who run the service and other things for patients in hospitals and general practice clinics?
Why is it, also, that in a money-oriented culture the answer is always more money? If the administrative structure does not accept its responsibility to run the service in the interests of the patients, from a senior level, the answer will always be more and more money because it is the easy way out, avoiding difficult management decisions. Conditions should be placed on the granting of new money to the Health Service to develop a sense of responsibility within it, so that senior people in the Health Service management feel that if a baby is going without an operation, that is their problem and their responsibility. They have £20,000 million to manage their affairs, so such things should not become matters for the national press and the House of Commons but should be dealt with at the local level.
It ill behoves people in the Health Service to grumble about recruiting nurses and other skilled staff when very often the labour organisations oppose the flexibility on pay which is needed to get nurses into the places as required. Why has there been so much delay in getting regional divergencies in pay and extra pay for special skills? Much of the problem lies with the Opposition and the unions, not with Conservative Members.
Who answers for the National Health Service? Managers must have powers and responsibilities to answer for the service delivery. I feel that within the administrative structures of the NHS there lies a deep hatred of the small hospital. Why does the NHS always go towards the large and the new, never supporting small community hospitals which are much loved by all hon. Members? It is not a matter of money; it is a matter of management style and it is high time that they were told that the small hospital is valued—

Mr. Rhodri Morgan: Will the hon. Gentleman give way?

Mr. Redwood: I do not have time to give way. It is not a matter of money and resource; it is a matter of management. We need the Bill, which is an important step on the road to providing a service with choice, management responsibility and a variety of sources of money and resource.
I welcome clause 4, which gives hospitals the opportunity to raise money and provide better services by bringing in private capital and skills. Why should patients and visitors not have the chance to get access to a different range of retail activities, types of food and drink and other necessary services? It is high time that hospitals were modernised, and we should encourage private capital and management to do it.
We need a system at general practitioner level to ensure that referrals to hospitals are made on good information about where waiting lists are shortest and where the patient can go, if he chooses, to have his operation performed quickly. There are glaring anomalies and a huge range of differences in standards of patient care that are entirely unrelated to resources and completely to do with management.
It is time that the GP had the power at his desk to help the system and the patient by reducing queues and waiting times by knowing where the shortest waiting lists are to be found. Why are out-patient clinics about the only places left where one can arrive for an appointment only to find that 30 or 40 others have been given the same time? It is not cuts that cause that to happen. That is the result of administrative decisions, and it is a disgrace. It is high time that out-patient clinics had sensible appointment times and that consultants adhered to them. That would greatly improve the standard of service and people's perceptions of it.
Throughout the service we need an ethos that is friendly to patients and marshals the huge resources of the NHS in the best interests of its patients and for no one else. We do not wish to see a producers' cartel. Nor do we wish to see a huge amount of resources going in at the top, and leading to expensive management games, endless rows and pieces of paper passing between regions, co-ordinators and the centre shifting the blame. We want resources to be directed to the bottom. The White Paper and the Bill offer choice and scope for additional funding. The Bill should be warmly welcomed. I hope that it is the first step of many.

Mr. Frank Haynes: I was not surprised by the contribution of the hon. Member for Wokingham (Mr. Redwood), who is one of the whizz kids of the Conservative party. He was working outside the House—

Mrs. Currie: Of course.

Mr. Haynes: I do not need the Minister to say "Of course". The hon. Gentleman was working outside the House on behalf of the Conservative party before 1979 when the policies that the Government are now putting before us began to be formed. I well remember what the Tories were saying during the pre-election period in 1979. I remember also what they did after the 1979 general election. It seems that all Conservative Members in the Chamber are laughing except one or two who were Members before 1983. The great majority of them are new boys.
During the 1979 election campaign the Conservatives were saying that if they formed a Government they would reduce public expenditure. They won that election and they have reduced public expenditure.

Mrs. Currie: That is right.

Mr. Haynes: I do not need the Minister to confirm or deny what I am saying. I am making a speech, not the hon. Lady.
The Government have made across-the-board cuts throughout the land. All services have been cut —[Interruption.] This is no joke; it is a serious matter. Before 1979 the Under-Secretary of State was implementing Conservative policies as the leader of the Birmingham health authority and cutting services. It is no wonder that the Health Service is in a mess when people such as the Minister were involved in health authorities. The hon. Lady is now a Minister and the actions that she is taking these days are even worse than those that she took when in Birmingham.
The Government have imposed cash limits and told health authorities that they cannot exceed them. They are warned that if they do they will suffer the consequences in following years. The message is, "Save your money and cut services." Everyone is scrimping and scraping within the Health Service to provide necessary services for the people, who are our constituents. We hear Conservative Members criticising some of the cuts in the NHS—some of them agree with the criticisms of Opposition Members— yet they vote to support the Government. I do not know how they get on when they return to their constituencies. They probably say that they did not vote to support the measures of which their constituents complain. I do not know what they say, but I know that the Government have created a begging society.

Ms. Harriet Harman: Quite right.

Mr. Haynes: I wish the Minister would keep quiet and listen. I never interfere when the hon. Lady is on her feet, so shut up!

Mrs. Currie: The hon. Member for Peckharn (Ms. Harman) interjected.

Mr. Haynes: There is evidence of the begging society in my constituency. The state should provide a heart scanner and yet the people of Ashfield and Mansfield have had to beg on street corners for donations to provide this necessary piece of equipment. There are people in desperate need who cannot afford the private sector, unlike so many Conservative Members. I have received a letter from the mayor of Eastwood town council in my constituency in which he refers to the Nottinghamshire kidney fund. I know of a chap who has worked his soul case out for 15 years to provide money for the fund. Tony


Higgins has begged on street corners and worked like a Trojan to raise money for kidney machines. Good luck to him, but this equipment should be provided by the NHS. In other words, it should be provided by the state.
When people are in work they contribute to the NHS by paying their national health stamp. The more one earns, the more one pays. There are billions of pounds being paid into the Government that should be used through the NHS to provide kidney machines and other vital items of equipment. Unfortunately, the money is not being used in that way. It is being used to pay for the advertising of share offers when public undertakings are being privatised. It is used to acquire weapons of destruction. By gum, we shall change all this when the Labour party forms the next Government.
It is sometimes necessary nowadays for individuals to lodge appeals when they need social security benefit. Benefit is often denied to them because of the regulations that the Government have introduced. Some of my constituents are on appeal because they say that they are entitled to benefit and the Department says that they are not. The hearing of an appeal can take as long as eight months. This is shocking. This has happened only since the Conservative Government—that lot on the other side of the Chamber — came into power. Under the Labour Government, those who were entitled to benefit received it. The present difficulties are related directly to public expenditure cuts.
We have been told by a Conservative Member that individuals value that for which they pay. That is true, but we are paying through the nose for the NHS without getting the value to which we are entitled. That is the problem, and that is what we must put right.
Every year the Nottingham Evening Post runs a scheme to raise money to keep the elderly warm. This leads to begging on street corners. The front page of the Nottingham Evening Post carries a headline which asks readers to contribute to enable the elderly to keep warm during the winter, and copies of it are sold by lads on street corners. It is the Government's responsibility to keep the elderly warm, but they are denying that it is. More and more people die each winter under the present Administration. Why is this? They are dying of hypothermia.
The end result is that we get kicked in the constituency and asked, "Why are you not doing something about it?" We are doing what we can in this place, but the Conservative Government have a majority of 101. They can get anything through. Conservative Members say that they do not agree with some of what the Government are doing, but they troop through the Lobby to approve it and to put it on the statute book.
Nottinghamshire county council and my district health authority are falling over backwards to try to provide additional chiropody services, but the county council — which, incidentally, does a marvellous job—is hampered by rate support grant cutbacks, and the chiropody services are suffering as a result. Not so long ago, the Minister talked of providing a decent service in the community, but what happens? People simply do not receive it.
Many doctors tell a retired man who has given a lifetime of service to industry to keep himself active. However, if that person requires a chiropodist—which is

often the case in my constituency—he will not be able to get about, because of his bad feet. He sits in a chair, day after day and week after week. Of course, such people can obtain a chiropody service if they pay for it, which is what Conservative Members want. However, because of rate support grant cuts and Health Service cutbacks in my district, a proper, full chiropody service cannot be provided.
It goes on and on. The poll tax is coming next. People will be asked to pay more and more — in particular, many of my constituents who are in the lower income bracket and who cannot afford chiropody in the private sector. They will be told that they must pay 20 per cent. of the poll tax. That means more and more money coming out of their pockets or their purses—if they can find it. That is what the Conservative meant in 1979—"Let us have cutbacks in the public sector. Let us make them pay." And, by God, that is what they have done. Well, once we are given the opportunity to sit on their side of the House and put things right, we shall really look after the people of this nation.

Mr. Michael Irvine: The hon. Member for Ashfield (Mr. Haynes) said at one point in his speech that Whips should keep quiet. All that I can say after the high-decibel hellfire sermon that we have just heard is that he is one Whip who certainly cannot be said to whisper his message.
What the hon. Gentleman said was more or less what we have been hearing from Opposition Members throughout the debate, although it was delivered at a rather higher volume and in a more declamatory manner than most of the other speeches. On the face of it, it fits in with the strongly expressed criticism from the eminent presidents of three senior medical colleges which was announced today.
Surely, however, the point is this. By its very nature, the National Health Service will always be short of resources. It will always be up against an ever-expanding demand. I am sure that, at any time during the 40 years since the NHS was set up, we could have found three eminent medical men to come forward and declare it to be in a state of crisis. We could also have found, on either side of the House—depending on which party was in power at the time — hon. Members such as the hon. Member for Ashfield declaiming the state of the NHS in pretty violent terms.
The fact is the better that the NHS does, the greater the expectations that it raises. The wider the range of treatments that it introduces, the greater will be the pressure on its resources. Forty years ago, for example, hip replacement operations simply were not available. Today, the NHS not only provides those operations, but provides them in ever-increasing numbers. Does it receive the credit for that improvement? It does not. Still less does the Government of the day. Expectations have been raised; the demand for such operations increases; the waiting lists are attacked as outrageous. That is likely to continue for as long as the NHS exists.
Obviously, taxation is always likely to play an important part in the funding of the NHS. I, for my part, hope that, in the years to come, insurance will play an increasing part in funding medical treatment. However, it is absurd not to look at other ways of raising finance. In particular, it is absurd for Opposition Members to dismiss


charges out of hand as a means of raising finance. If medical services are provided free — indeed, if any services are provided free — there will be waste, and where there is waste less money is available to be used where it is most needed. Charges have a very important part to play in making sure that such waste does not occur.

Mr. Morgan: Will the hon. Gentleman give way?

Mr. Irvine: I should like to give way, but I know that another Opposition Member wishes to speak after me.
Charges reduce waste. Resources can then be better applied in other directions. My hon. Friend the Member for Wells (Mr. Heathcoat-Amory) made the point that an important merit of charges is that they involve patients much more in improving the efficiency of the National Health Service. If we pay for something, we try to ensure that we get good value for it. Furthermore, charges provide a useful additional source of finance.
There is scope for argument about exactly what the level of charges should be and exactly how and on what items charges should be applied. There is also scope for argument about the level of income above which charges should become payable. If sensible charges are imposed on those who can afford them, they are not merely unobjectionable; they are positively desirable.
The other main way of raising money is embodied in clause 4, which to my mind is the most encouraging part of the Bill. It is high time that hospitals were encouraged to make greater use of their commercial potential. There are large numbers of staff, patients and visitors in hospitals. This makes hospitals very attractive as premises to retailers.
There is other commercial potential too. I do not wish to embarrass the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), but he highlighted one of the other revenue-raising elements that, apart from the attraction of hospitals to retailers who might want to set up shop there, is available to hospitals. He referred to commercial deals with drug companies. In exchange for research and assistance, hospitals could strike advantageous deals with drug companies. That is specifically provided for in clause 4(1)(e). The potential is enormous.
During the opening speech of my hon. Friend the Minister, my hon. Friend the Member for Langbaurgh (Mr. Holt) in an intervention highlighted the fact that each hospital or at any rate each regional health authority must be allowed to retain the benefit of its commercial success. That must be right. It would be absurd and counterproductive if the benefits of the commercial success by individual hospitals and regional health authorities that is made possible by clause 4 were to be nullified by a subsequent corresponding reduction in central funding.
The Bill has met with much undeserved criticism. By and large, it is a very good Bill. I shall vote for it with enthusiasm.

Mr. Keith Vaz: It is always a pleasure to follow the hon. Member for Ipswich (Mr. Irvine). He claims a special interest in practically every debate. He last spoke in a debate on Scotland, which is strange for a Member who represents a constituency in East Anglia.
Conservative Members have made great play of the fact that they are seeking to reform the Health Service. Indeed, one Conservative Member posed the question: "What sort

of Health Service will exist in 20 years?" It is obvious, not only from the Bill but from the debate that was held two weeks ago, that in 20 years' time we shall have a private health service because the National Health Service will have ceased to exist.
Some comments, especially those by the hon. Member for Wokingham (Mr. Redwood), who has now left the Chamber, are based on fantasy recollections about the natural consumers of the Health Service. When one considers that the hon. Member for Wokingham happens to be a former investment consultant for N. M. Rothschild, one realises that such Conservative Members have no understanding of the needs of the people who seek medical and dental help. Indeed, the Parliamentary Under-Secretary, the hon. Member for Derbyshire, South (Mrs. Currie), seems to operate on the basis that if the Ministry issues a directive to tell people not to be ill, they will cease to be ill, and that if a directive is issued telling everyone in, for example, Leicestershire that they do not have any health problems and have no need to seek a dentist or optician, suddenly, by some miracle, all their problems will disappear. Of course, the reality is quite different.
My hon. Friend the Member for Wolverhampton, South-East (Mr. Turner) referred to the state of the Health Service in his area. I should like to give briefly some statistics relating to the Health Service in Leicestershire. About 8,300 people are on the waiting lists in Leicestershire and about 1,300 are waiting for urgent operations—that is almost 13·6 per cent. of the total.
Even before the provisions of clause 4 become enacted, we have been operating a jumble sale Health Service. The Lord Mayor of Leicester recently launched an appeal for support to build a special unit at the Leicester general hospital. The appeal reached £50,000 but everyone has now discovered that an extension will not be built at that hospital in which to put the new endoscope unit. When clause 4 becomes law — if it becomes law — we shall indeed have a jumble sale Health Service in which the managers of health authorities will, no doubt, hold television game shows and jumble sales to raise funds.
A recent report in Leicestershire stated that the Towers hospital, which is a regional hospital that helps patients with mental disorders, is recommended for closure. I raised that in a question to the Minister, but she has not even seen the report. However, we have been told that it will close in five years. I understand that consultants in Leicestershire are furious about what is happening and about the fact that beds that are needed for operations are not available. Those consultants are to lead a delegation to the Minister in the near future.
We have heard reports in Leicestershire that funds from the National Health Service will be allocated to private hospitals. Indeed, there has been rumour that £240,000 of National Health Service money would be spent on private services in Leicestershire. That is the state of the Health Service in Leicestershire and it is wrong for the hon. Member for Wokingham to say that everything is all right with the Health Service and that it is getting value for money.
In a recent article in a local newspaper, Mr. Paul Bates, the administrator of the family practitioner committee, quite controversially for an administrator in the Health Service, criticised the Government because of the cuts that will be made in the local FPC. It is being told that it cannot circulate vital information to doctors and dentists, that it


should slash £50,000 from its budget, that it should not write to 60,000 people a year to tell them that their doctor has retired or died, and that it should not write to 13,000 "season ticket" holders to tell them that their annual permit for regular drugs has expired. It is not allowed to send out annually updated drugs lists to doctors, which give them vital information when they need to prescribe for their patients.
At present there is so much scope to introduce a Bill which will provide resources and a more efficient NHS. No one is pretending that the operation of the NHS is perfect; obviously, there are tiers and layers of management which need to be examined carefully. It is fundamentally wrong that the Government should be allowed to appoint managers from Sainsbury's or other high street firms to become general managers of acute hospitals. That practice must be stopped.
I should like to see a Health Service in Leicestershire, particularly in Leicester city, which provides for the outer estates, such as Netherhall, Thurnby Lodge, Rowletts Hill and Northfields, where there are large council estates and no general practitioners. During the past year, there has been a campaign in Rowletts Hill to set up a baby clinic because mothers cannot take their children into the city centre to have them treated. Recently, a campaign was started to try to provide general practioner facilities in the neighbourhood centres that have been provided by the Labour city council.
We are talking about the erosion of fundamental rights.

Dame Jill Knight: I was fascinated and wondered what significance there was in the fact that the hon. Gentlemen removed his shoes before he made his speech. Is he having problems with the chiropody service in Leicester?

Mr. Vaz: If the hon. Lady were to visit Leicestershire health authority she would discover that there are severe problems with the chiropody service and that people cannot get the treatment that they need. But that intervention was not particularly relevant to what I was saying.
During the past 20 years, there has been a consensus that the NHS should be supported by both the Government and the Opposition because it is a fundamental right. That right was accepted by the previous Conservative Administration between 1970 and 1974 under the previous Conservative Prime Minister, who is now attacked and humiliated by Conservative Members. We believe that the Health Service is a fundamental right, free at the point of entry and available for all.
The end of the long road on which this Bill embarks is people being charged for a visit to their GP, just as it is proposed that they will be charged when they visit their dentist or optician. The Bill is appalling. It does not serve the needs of local people and those who rely on the NHS, and I hope that it will be opposed.

Ms. Harriet Harman: The Bill is introduced by a Government whom no one in the Health Service trusts any more. That is not surprising because they are presiding over an awesome restriction on our health services, but they do not even have the integrity to admit that that is the case. Therefore, people will, rightly, not

take at face value the suggestions and powers in the Bill, including, for example, the supposed additional powers for financing the Health Service.
The Minister said that the legislation was about bringing extra funds into the Health Service, but it is absolutely clear from our remarks that we simply do not believe him. The Government's dogged refusal to recognise that there is a problem of underfunding is also absolutely clear. Less than two weeks ago they tabled a motion congratulating themselves on the adequacy of their NHS funding. They do not believe that it is underfunded, and they have shown great anxiety to bring about a major reduction in public spending. That is what the Bill is about. It should have been introduced by the Chancellor of the Exchequer, not by health Ministers. It is shameful that health Ministers are, in practice and in fact, doing the dirty work of the Chancellor of the Exchequer, because the Bill is about reducing further the funds to health authorities.
The Minister said that health authorities must take time off from easing suffering and curing diseases, and must set about the task that the Government think is much more important, which is making money. Health Service managers are rightly cynical about the proposals, and they are convinced that any money that they raised in addition to their existing budget would be clawed back by the Government. They believe that the reward for raising an extra £1 million would be that the following year they would have £1 million taken off their budget by the Government. They believe that, if they raised £2 million, the Government would take back £2 million the following year. Worse, they fear that the Government will make some sort of arbitrary assumption about how much money it is appropriate for each district health authority to raise, and will cut their budget in advance irrespective of whether they raise that amount of money.
It is not just that we fear that the Bill will not involve extra resources for the Health Service. It will also provide a considerable distraction from the job that the Health Service should be doing. Health Service administrators will have to set about leasing Health Service land for camping and caravan sites, running shopping malls and health clubs.
The Minister should make it quite clear tonight what the Government will ask the Health Service to do to try to raise that money. Will they really ask district health authorities to sign deals with undertakers and to set up hotlines for bereaved relatives? We should like to hear the answer tonight in the House. Will he force district health authorities to put up the prices of welfare food? We should like to hear about that tonight as well. Will they make health authorities put up the price of meals in staff canteens and make staff pay for car parking facilities? If they adopt that measure, they will further undermine the standard of living of nurses which will lead to a greater exodus of nurses from the Health Service.
Will the Government ask health authorities to insist on charges for relatives who stay with a sick child in hospital? I should like a specific commitment that the Minister will not ask district health authorities to do that. It is important that, when a child is in hospital, parents are encouraged and enabled to stay with the child to assist the speedy recovery of that child. It would be quite wrong to implement charges for relatives of children in hospital. If there were already charges for relatives, David Barber's


mother would be receiving a bill from the health authority in two weeks' time. We must have an assurance from the Government that they will not introduce such charges.
Perhaps the Minister will inform the House which of the 75 suggestions in the leaked report in The Independent they will approve and which they will not be going forward with. It would be helpful if a copy of that report, which was leaked to The Independent, were placed in the House of Commons Library so that Members could scrutinise it. Tonight, we need to know exactly what district health authorities will be forced to do to raise money. Instead, district health authorities should be directing their energy and initiative to improving health care. Already there is a considerable diversion of energy and initiative towards basic fund raising. We want consultant paediatricians to be treating sick children, not spending hours on fundraising committees or telephoning round local companies trying to raise money for basic services.
We are talking about fund raising for basic services, and not just for some additional extras. For example, I received a letter from a consultant at Haringey hospital which was sent to all local organisations asking for money for the appointment of a senior registrar in the microbiology department. That is a department in Haringey hospital, in north London, which obviously has a key role in preventing the spread of infectious diseases such as hepatitis B and AIDS. It is scandalous that, when its work is increased, it has to write to local organisations to try to drum up the £20,000 needed to fill that post. The letter states:
I think it is imperative for this community to benefit from such a post and I am therefore writing to appeal to you to seriously consider whether this might be a possibility with your assistance. We are looking to find the sum of £20,000 a year ongoing.
That is how the Health Service is having to operate already. If district health authorities have to put even more effort into trying to raise money in that way, the position will deteriorate even more.
The Bill talks about extra resources for the National Health Service, but the underfunding of the Health Service is already choking off and having a chilling effect on voluntary and charitable fund raising. What is the point of spending all one's spare time raising funds to buy the local hospital a special care baby cot if it lies unused because of the nursing shortage? What is the point of raising money to establish a kidney unit if the hospital in which it is to be based is later closed?
The efforts of hospital leagues of friends to raise thousands, hundreds of thousands and even millions of pounds are increasingly swallowed up in the widening black hole of NHS underfunding. That is demoralising them and undermining their will to help to raise funds for the Health Service. Charities are becoming angry. The fact that the Government are undermining existing opportunities to raise money—

Mr. Tony Favell: The hon. Lady said that she wants better and more equipment in the National Health Service, more money for staff, more staff and more buildings. How many billions of pounds would a Labour Government invest in the Health Service?

Ms. Harman: The British Medical Association, the Institute of Health Service Managers and the Royal College of Nursing have said that, to escape from chronic

underfunding, the Health Service needs an extra £200 million a year. Later in my speech I will discuss how the Government are wasting Health Service assets.

Mr. Redwood: Does the hon. Lady accept that £200 million a year is a small sum? Is she aware that next year the Government will put an extra £700 million into the Health Service? Why is that inadequate? If she means billions of pounds, why does she not say so? But how would that agree with the hon. Member for Livingston (Mr. Cook), who said that a few hundred million pounds would do?

Ms. Harman: Those organisations say that we need £200 million on top of what the Government have said that they will put into the Health Service.
Charities are becoming angry that the Government are increasingly pulling out of key areas in the Health Service and leaving charities to carry the can. Last week, the Imperial Cancer Research Fund bitterly attacked the Government, saying that charities must increasingly prop up the Health Service and that money intended for research into cancer is being sucked into supporting basic services. The fund is sustaining the children's ward at St. Bartholomew's hospital. That should be funded from the mainstream budget; it should not be left to a charity to fund. The fund is supporting most of the cancer treatment, not just the research, at the unit being set up at the Churchill hospital. The shortage of funds is delaying new treatment for cancer patients.
But all this does not seem to bother the Government. Indeed, 10 days ago the Under-Secretary gave the game away when she complained that every new medical treatment created a new waiting list. The Government sees this as a problem. They would be much happier if medicine had not much progressed beyond Victorian times, so that they could say to people, "I am sorry, but we can do nothing for you. You will have to go home." In that way, they could save a great deal of public money.
The Government's obsession with cutting public spending has led to their being the enemy of progress. It has led to their being the enemies of life-saving treatments and of the medical breakthrough. Like most normal people in this country, we want to see medical advance. We see the Health Service as a marvellous asset towards that end. The Government see the National Health Service as a greedy obstacle in the path of their plans to cut public spending.
The Government speak of selling spare capacity to the commercial medicine sector. We see this in clause 4. They talk about it as a way of bringing income into the Health Service, but my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) is right when he says that we must scrutinise this notion of spare capacity being available for selling to the commercial sector. The cheerful talk of spare capacity will cut no ice with the 162,000 people who have waited over a year for medical treatment and who continue to wait. Spare capacity is not a concept which would be understood by the parents of David Barber or by eight-year-old Emma White who waited eight months for an operation. When she finally came to the head of the queue and went into hospital, she waited 17 hours and was sedated for her operation in the Royal Berkshire hospital, only to be told, "Very sorry. You'll have to go home. Your operation can't go ahead." It is odd for a Government who like to talk of the insatiable and


escalating demands of the Health Service to start talking about spare capacity. They are not really talking about spare capacity. They are talking about asset-stripping the Health Service for the purpose of commercial medicine.
There is in the Health Service not so much spare capacity as much-needed assets which are locked up and underused because of underfunding. The Government urge the Health Service to be more efficient and to cut out waste, but their under-resourcing and underfunding of the Health Service are leading to inefficiency and waste.
The Government rightly talk of their concern about taxpayers' money. We are also concerned about the fate of taxpayers' money in the Health Service. Taxpayers have invested millions of pounds in operating theatres and yet they are used for only half the time for which they could be used. They lie idle for the rest of the time. This is not so much spare capacity as a valuable resource which is underused and lying idle. Those operating theatres are not used, because operations are cancelled in a bid to save money and because there are not the nurses or beds available for people when they have had their operations.

Mr. Churchill: I sympathise with some of the hon. Lady's points, but I fear that she does her case no good by her exaggeration. When her Government were in power, constituents of mine had to wait more than a year to get an X-ray for their stomach. For one of my constituents, the notification that he could go for his X-ray came the day after he died.

Ms. Harman: I am not exaggerating. The statistic about operating theatres being used for scarcely half the time comes from a report written by the National Audit Office which was published the week before last.
Taxpayers also invest millions of pounds in training doctors and paying their salaries, but they are then banned by the district health authorities from operating on patients on the waiting list for fear that the budget might be overspent. All the resources and taxpayers' money that go into training doctors and keeping them on the NHS payroll are then underused as they remain idle and frustrated.
Millions of pounds are being lost to the Health Service through theft and underfunding of security measures means that easy pickings are available. Millions of pounds are also lost to the Health Service through the exodus of nurses. My hon. Friend the Member for Bolton, South-East (Mr. Young) was right in his explanation of the problem.
The replacement cost for nurses to the Health Service is something like £100 million a year. Another £40 million a year leaves the Health Service with the nurses who do not complete training. The Minister has said that that has nothing to do with resources. It has everything to do with resources. Who thinks that we would have an exodus of 30,000 nurses a year from the Health Service if they were better paid, if there was a sensible grading structure, and if they were offered flexible hours and child care provision for pre-school age children? If nurses had better conditions such as those, they would stay with the Health Service and that would be a much better return on taxpayers' money. It would also mean that the nurses could be where we want them to be, and where they want to be—at the patient's bedside instead of leaving the Health Service in frustration and desperation.
With regard to nurses, the Government have much in common with first world war generals whose attitude was that it did not matter how many soldiers did not return from the front, because there would always be more recruits. But there are not enough nursing recruits. The Government's attitude is a huge drain on the training and investment on nurses.
Millions of pounds are invested in beds, wards and equipment which are wasted because they lie idle as a result of service cuts. In any hospital in any town or city, equipment is piled up and lying idle. That is a shameful waste of resources that could be utilised. The Government are also generating inefficiency. Doctors are involved increasingly not so much in treating patients, but in spending hours on the telephone trying to find beds for patients. That is not what they were trained for or what they should be doing in the Health Service. Towards the end of every day doctors scour the wards looking for any patient who appears to be perky enough to be sent home so that they can free a bed. That is not how we should be running the Health Service. There is also a booming administration industry. Letters are sent to patients booking them in for operations, and letters are then sent cancelling the operations.
Great inefficiency is also generated as a result of the recruitment freeze which is now beginning to bite in district health authorities. Providing health care is team work. There must be a complete chain to make the system work properly. If there is a freeze on the recruitment of nurses, the doctors and lab technicians will not be able to do the jobs that they were trained for and that we need them to do. If there are not enough lab technicians, the doctors cannot do the work that they should be doing and the nurses will not be able to do their work.
The irony is that, because of the district health authorities' underfunding, many district health authorities have to implement recruitment freezes. We have not heard a squeak from the Government about recruitment freezes. Are the Government unaware of the present position? Are they unaware that many more district health authorities are threatening not only to introduce recruitment freezes in an attempt to meet their budgets, but to extend that recruitment freeze to nurses? The Government have remained absolutely silent on that matter.
It is also clear that the Government's concern to improve services in primary health care takes second place to their anxiety to cut public spending. They say that they want to gear the service to prevent ill health and promote good health, yet they cast a shadow across those objectives by planning to introduce charges for eye tests and dental treatment. The hon. Member for Birminham, Edgbaston (Dame J. Knight) was absolutely correct when she set out those arguments. It is obvious that there will be a reduction in screening and preventive treatment.
The Government are also taking powers to cash-limit the family practitioner committees. The BMA echoed the fears of many when it called for the relevant clause to be removed from the Bill. It said:
GPs know only too well the consequences of the application of cash limits to the hospital sector and the difficulties created for their patients.
If the clause is included and if the Bill is passed, we will see the same crisis hitting the primary care system as we see developing in hospitals.
The Government's plans to improve GP services are also undermined by their failure to fund the family


practitioner committees, which should represent a powerful watchdog to plan and supervise an improvement in services. Unless there is proper planning and supervision of such improvements, the improvements that the committees seek in the GP services will not occur. The committees' attempt to argue for such improvements will be nothing more than a pious hope.
The Government are distorting our hospitals and blighting our primary care system by their desire to pull the plug on the Health Service. However, a growing number of people are working together to try to prevent the Government from doing so. Doctors are worried. We have seen the report issued today from the three royal medical colleges. Nurses are angry and are demonstrating. In Cornwall 1,000 nurses have been demonstrating on the streets against the cuts that face a hospital in that region. Health Service managers are growing hoarse from complaining and predicting dire problems. The Government are not listening to any of those people.
The Opposition are listening to the doctors and nurses and to patients who are waiting anxiously for treatment. We will be working to try to prevent the deterioration of the Health Service that is represented by the Bill. It is a pity that so many Conservative Members are afraid to stand up for their constituents by trying to defend and protect the Health Service in their areas.

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie): This has been a thorough, wide-ranging debate on primary care and the provisions of the Bill.
Large parts of the Bill have received a fair measure of support. I am most grateful to my hon. Friends the Members for Norfolk, North-West (Mr. Bellingham), for Warrington, South (Mr. Butler), for Wells (Mr. Heathcoat-Amory), for Ryedale (Mr. Greenway), for Wokingham (Mr. Redwood), for Ipswich (Mr. Irvine) and a number of others. I am sure that they will understand if I do not answer all their points in detail.
The hon. Member for Peckham (Ms. Harman) asked a number of questions, especially regarding the items in clause 4. I must tell her that we have no such plans as she has outlined. The hon. Lady asked that we place the internal report that we have received in the Library, but the answer to that request is no. Quite simply, the reason for that decision is that the report contains some batty things—which she has described—with which we do not agree, such as a hotline to funeral parlours. The hon. Lady also asked about the price of meals in staff canteens. I must confess that one of the things that I did in Birmingham when I was chairman of that health authority was to investigate the biggest subsidy of all for staff dining—the consultants' dining room at the Queen Elizabeth hospital. I tried to do something about that.
The hon. Member for Livingston (Mr. Cook) made a most interesting speech. In many ways it was an excellent speech for a different purpose—an excellent speech for the deputy leadership of his party. It was a pity that so few of his Back-Bench colleagues were present to hear it at 5 o'clock. We counted 12 of them and we wondered what had happened to the other 200. I listened carefully to his comments, especially those concerning the General Practice Finance Corporation and his comments regarding clauses 4, 8 and 10. I do not know who is advising the hon. Gentleman, but he is not very good. The GPFC will have

a much easier time in future when it will be able to raise money outside Government funding. In any case, many GPs already raise a substantial amount of money to fund their activities. That has been done exceedingly well in Stratford where the GPs are only too pleased to show off what they have done.
The hon. Members for Livingston and for Peckham gave us quotes to show that the British Medical Association does not like the proposals in the Bill. I wonder whether they saw the letter from Dr. Wilson, chairman of the general medical services committee, of the BMA, printed in Today on 4 December. That article was headed:
Doctors had the best ideas first.
I will not quote the whole letter but he clearly stated:
The BMA committee which represents all general practitioners proposed most of the innovations which the Government has put forward.
I am more than happy to accede to that. The hon. Member for Livingston asked whether clause 8 will allow charges to be made in respect of general practitioners. If he is asking whether clause 8 will allow for the imposition of a charge for a GP's consultation, the answer is no. Similarly, there are no powers in clause 4 to make patients pay for basic health care. We are concerned with income generation, not income replacement. That answers the point raised by another colleague. What it will allow for is charging for special services, just like the old amenity beds which the legislation is to replace. But nothing will get in the way of giving basic health care, and that is clearly set out in both the Bill and the White Paper.
I note the remarks of the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). I will try to do what the doctor tells me in future. He asked me about payment for domiciliary visits and merit awards for doctors. I will convey his views to the British Medical Association. Whether it will take any notice is another matter.
I also note his comments about drug companies and whether we should charge them for the research that we do on their behalf. I take his point, but will merely say that all their research is done on our behalf because we do not fund pharmaceutical research in this country. The Health Service, the Government and the public benefit considerably from the research and the trials that are done under properly controlled conditions in our hospitals.
The hon. Member also asked about charges for private patients in private hospitals. He and his colleagues ought to read clause 4 a little more carefully; I think that they will find that they agree with it. The whole idea is to free our hospitals through clause 4 to enable local managers to charge whatever they like. At the moment, they cannot make a profit and are not allowed to charge for some of the services which Labour Members identified. So we hope that they will vote for the clause. This applies also to the hon. Member for Bolton, South-East (Mr. Young), who called private patients parasites. One of the reasons is that we cannot charge them as much as we ought to.

Mr. Galbraith: I thank the Minister for taking my advice. If she sticks with me, she will be all right.
I obviously did not make my point clear. I was talking about the situation in which the patient is seen privately and then comes into the National Health Service as a National Health Service patient, or someone who is in a private hospital and then moves to a National Health Service hospital. Such patients are not charged at the moment. I do not wish them to be charged—they are as


entitled as anyone else to National Health Service treatment—but I want the private company which puts them into the National Health Service hospital to be charged because we are giving a cross-subsidy to that private company. Will the Government look into that?

Mrs. Currie: I could not agree more. I assure the hon. Gentleman that clause 4, for which I hope he will now vote, will give us the power to do much of what he wants to do.
The hon. Member for Greenwich (Mrs. Barnes) raised a number of points. She said that capitation fees should be adjusted to avoid reducing the time allowed for patient consultation. It is proposed in the White Paper to extend the number of hours that a general practitioner makes available for direct consultation to the patients, which will confer the entitlement to the full basic practice allowance.

Mr. Young: rose—

Mrs. Currie: This, together with the provisions to improve consumer choice and to make it easier to change doctors, should increase competition among doctors and lead to better services for patients. In other words, if patients are not given enough time by doctors they will now be able to do more about it.
If the hon. Lady has any further concerns, may I just refer her to an important book written on the subject in 1976, in which it says:
The key to the future lies in sensible and realistic planning to ensure that revenue and capital resources are allocated on the basis of objective criteria, that capital developments proceed at a pace consistent with a realistic revenue projection and that revenue costs and manning levels are kept to an essential minimum … No one who works in the Health Service can avoid the need to examine their practices and attitudes with a view to seeing if the overall cost-effectiveness of the service can be improved".
I could not agree more. That was said by the right hon. Member for Plymouth, Devonport (Dr. Owen), when he was a Labour health Minister, at this Dispatch Box. I would refer the hon. Lady to her leader, if she can find him; he does not seem to take as much interest these days in these subjects.
That also answers the point made by my very dear—may I call him Friend?—the hon. Member for Ashfield (Mr. Haynes), who wanted to know what I was getting up to in Birmingham before 1979. The answer is that I was doing my best to resist carrying out the policies of the then Labour Government on the Health Service, when it was being cut to shreds.
A number of my hon. Friends have raised important points. As usual, my hon. Friend the Member for Eastleigh (Sir D. Price) made a thoroughly sensible and distinguished contribution. He asked about average list size. I should just caution him on this. We are keen to reduce the average list size, as he knows, but large numbers on lists are most common in the inner cities, where we also have a high percentage of doctors who are over 70, and many small lists of fewer than 1,000. So we see major changes here, and it is hard to tell exactly what effect the retirement provisions will have on list size. In the end, we are also interested in the output and results that we get. As I am sure my hon. Friend realises, list size is an input.
We are also keen about the commitment to extra resources. I am sure that my hon. Friend realises that some negotiations are going on. We shall have more discussions,

particularly with the doctors, so I am a little reluctant to put our negotiating position on the table just yet. I hope that my hon. Friend will accept that.
Several of my other hon. Friends made points, which I shall deal with as I make my speech.
Various hon. Members drew attention to the division between the family practitioner committees and the district health authorities. I have some sympathy with that, but we are stuck with it. The arrangements were confirmed as recently as 1985. I hope that hon. Members will understand that I am reluctant to reorganise the Health Service all over again. I think that it has had enough for the time being. I can see virtue in having the services outside the hospital run by separate bodies, especially as some district health authorities seem to have difficulty running what they have. The aim is to make the family practitioner committees as effective as they can be, so that they do a proper job of monitoring health and the family health services. That is what we intend to do through the Bill.
Nobody can say that we have been stingy with these services. [HON MEMBERS: "Yes, you have."] Opposition Members cannot say that. I am talking about the family practitioner services, which have been given less attention in the debate than they should have received. In 1978–79, gross current spending on the family practitioner services under the Labour Government was about 1–75 billion. It has trebled since then in cash terms and is over £5 billion now. In real terms, that is an increase of 43 per cent. That expenditure represents 24 per cent. of total Health Service spending, which is an increase on the years under the Labour Government.
Since 1979, the number of family doctors in the United Kingdom has risen by nearly 4,000 and now stands at over 30,000. Similarly, the number of staff employed by family doctors in England alone has risen to nearly 30,000, and that is in whole-time equivalents. That is probably about twice as many people.
The number of dentists in the United Kingdom has increased by nearly 3,000 to over 17,000. The number of retail pharmacies in England and Wales has gone up to 10,500 now, and we have 38 per cent. more ophthalmic opticians in England and Wales—around 6,000 of them. I shall come back to them in a moment.

Mr. Morgan: Before the Minister is overcome in a paroxysm of self-congratulation and requires medical attention herself, does she accept that there is genuinely a problem of incentive in the NHS, for surgeons and other medical practitioners who attempt to eliminate the waiting lists and find themselves up aganst the cash limits? When they are trying to do that, their general unit manager tells them half way through the financial year, "Sorry, you have done enough operations now. You've got to stop."

Mrs. Currie: I take the hon. Gentleman's point, but we have been increasing the incentives for general practitioners, dentists, opticians and pharmacists. As a result, we have many more of them. That is what happens when one gives incentives.
Similarly, the number of courses of treatment has risen dramatically. The number of eye tests now stands at nearly 11 million. The number of courses of dental treatment has gone up in the past 10 years from 26 million to over 31 million, of which 10 million are children. Nearly 3 million pairs of spectacles were issued last year, 209 million visits


were made to doctors, and 34 million visits were made by doctors to the home of the patient. Nearly 1 million women went to ante-natal classes in 1985 and the same number of pregnant women had their teeth done at an average cost of nearly £32 each — free to them, of course. My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) is right. There is no evidence that teeth deteriorate in pregnancy, but women tend to get gum disease. Therefore, we have no proposals to change that.
There have been some reductions. There are fewer holes in children's teeth. Half of our children start school with their teeth intact, compared with only a quarter of them when my daughter was born in 1974. About 40 per cent. of those aged 65 to 74 — I am looking at the hon. Member for Ashfield—have their own teeth and expect to keep them. In 1985, 1·7 million pensioners received dental treatment.
Hon. Members on both sides talked about charges. I share the sadness—the hon. Member for Ashfield is not showing his teeth now — of several hon. Members who said that charges for sight and dental checks have obscured discussion on a wider range of worthwhile proposals. However, I have several points to make in this regard. First, for many people, such checks are free and will continue to be so. No one will be denied the service because he cannot pay. About 15 million courses of dental treatment are free—about 45 per cent. of the total—and 2·25 million vouchers for spectacles were issued last year —25 per cent. of the total—and we have no plans to change the exemptions. The proposed charges are hardly high — less than £3 for the dental check-up every six months. That is less than the price of two packets of cigarettes—not every day, but once every six months. Even after the charges are brought in we reckon that more than 2 million courses of dental treatment will be cheaper than they are now. Of course, the idea is to help those who look after their teeth, as my hon. Friend the Member for Ryedale pointed out.
As for the eyesight test, we are convinced that people will not have to pay a fee of the order of £10. The opticians' service is profitable and competitive. Hon. Members on both sides of the House should have a look at The Optician magazine. With the permission of the House, I shall read out some of the recent advertisements for opticians working in the private sector. This one comes from Haywards ophthalmic opticians in Derby, Oadby, Thornaby-on-Tees, Bournemouth, Gateshead, Shrewsbury and Coventry. It offers a salary package in excess of £30,000 for a four-day week, a company car, a pension and a private health scheme. A similar advert earlier in the year states that the private car is a
new 2 litre petrol injection Sierra.
An advertisement for an ophthalmic optician in Exeter offers a salary package of £35,000 plus. I can well understand—

Mr. Robin Cook: rose—

Mrs. Currie: —that under these conditions opticians do not like what we are up to. I am sorry if my hon. Friend the Member for Edgbaston thinks that we are being offensive; but we think they will manage somehow.

Mr. Cook: The Minister will appreciate that we are concerned not about optometrists who earn in excess of £30,000 but about the 6 million pensioners existing on

much smaller incomes, who will be faced with a charge to which the hon. Lady is exposing them. Will she admit that she is leaving them open to whatever the market charges them?

Mrs. Currie: The hon. Gentleman was not here for most of the debate. If he had been, he would have heard some of the answers to that.
I am prepared to extend the hand of friendship to the Opposition and to invite them to stand by their principles — that they care about prevention and good health, women's health, more women doctors and the inner cities —and I invite them to vote with us tonight. If they join us in the Lobby, they will show that they know what they want and what we need for primary care, and are willing to pay for better-trained staff in doctors' surgeries, for interpreters and link workers for ethnic minorities, for staff working with the housebound and the disabled and for the health of our own people. If they do not, one can only conclude that they are more interested in playing politics with the sick than in supporting change to improve health. That is our policy. I commend the Bill to the House.

Question put, That the Bill be now read a Second time:

The House divided: Ayes 318, Noes 220.

Division No. 106]
[10 pm


AYES


Aitken, Jonathan
Butcher, John


Alexander, Richard
Butler, Chris


Alison, Rt Hon Michael
Butterfill, John


Allason, Rupert
Carlisle, John, (Luton N)


Amess, David
Carlisle, Kenneth (Lincoln)


Amos, Alan
Carrington, Matthew


Arbuthnot, James
Cash, William


Arnold, Jacques (Gravesham)
Chalker, Rt Hon Mrs Lynda


Arnold, Tom (Hazel Grove)
Chapman, Sydney


Aspinwall, Jack
Chope, Christopher


Atkins, Robert
Clark, Hon Alan (Plym'th S'n)


Atkinson, David
Clark, Dr Michael (Rochford)


Baker, Rt Hon K. (Mole Valley)
Clark, Sir W. (Croydon S)


Baker, Nicholas (Dorset N)
Clarke, Rt Hon K. (Rushcliffe)


Baldry, Tony
Conway, Derek


Banks, Robert (Harrogate)
Coombs, Anthony (Wyre F'rest)


Batiste, Spencer
Cope, John


Bellingham, Henry
Cormack, Patrick


Bendall, Vivian
Couchman, James


Bennett, Nicholas (Pembroke)
Cran, James


Biffen, Rt Hon John
Currie, Mrs Edwina


Biggs-Davison, Sir John
Curry, David


Blaker, Rt Hon Sir Peter
Davies, Q. (Stamf'd &amp; Spald'g)


Body, Sir Richard
Davis, David (Boothferry)


Bonsor, Sir Nicholas
Day, Stephen


Boswell, Tim
Devlin, Tim


Bottomley, Peter
Dickens, Geoffrey


Bottomley, Mrs Virginia
Dorrell, Stephen


Bowden, A (Brighton K'pto'n)
Douglas-Hamilton, Lord James


Bowden, Gerald (Dulwich)
Dover, Den


Bowis, John
Dunn, Bob


Boyson, Rt Hon Dr Sir Rhodes
Durant, Tony


Braine, Rt Hon Sir Bernard
Evans, David (Welwyn Hatf'd)


Brandon-Bravo, Martin
Evennett, David


Brazier, Julian
Fairbairn, Nicholas


Bright, Graham
Fallon, Michael


Brittan, Rt Hon Leon
Farr, Sir John


Brooke, Hon Peter
Favell, Tony


Brown, Michael (Brigg &amp; Cl't's)
Fenner, Dame Peggy


Browne, John (Winchester)
Field, Barry (Isle of Wight)


Bruce, Ian (Dorset South)
Finsberg, Sir Geoffrey


Buchanan-Smith, Rt Hon Alick
Fookes, Miss Janet


Buck, Sir Antony
Forman, Nigel


Budgen, Nicholas
Forth, Eric


Burns, Simon
Fowler, Rt Hon Norman


Burt, Alistair
Fox, Sir Marcus






Freeman, Roger
Lloyd, Sir Ian (Havant)


French, Douglas
Lloyd, Peter (Fareham)


Gale, Roger
Lord, Michael


Gill, Christopher
Luce, Rt Hon Richard


Gilmour, Rt Hon Sir Ian
Lyell, Sir Nicholas


Glyn, Dr Alan
McCrindle, Robert


Goodhart, Sir Philip
Macfarlane, Neil


Goodlad, Alastair
MacGregor, John


Goodson-Wickes, Dr Charles
MacKay, Andrew (E Berkshire)


Gorman, Mrs Teresa
Maclean, David


Gorst, John
McLoughlin, Patrick


Gow, Ian
McNair-Wilson, M. (Newbury)


Gower, Sir Raymond
McNair-Wilson, P. (New Forest)


Grant, Sir Anthony (CambsSW)
Madel, David


Greenway, Harry (Ealing N)
Major, Rt Hon John


Greenway, John (Rydale)
Malins, Humfrey


Griffiths, Sir Eldon (Bury St E')
Maples, John


Griffiths, Peter (Portsmouth N)
Marland, Paul


Grist, Ian
Marshall, John (Hendon S)


Ground, Patrick
Marshall, Michael (Arundel)


Grylls, Michael
Martin, David (Portsmouth S)


Gummer, Rt Hon John Selwyn
Mates, Michael


Hamilton, Hon A. (Epsom)
Maude, Hon Francis


Hamilton, Neil (Tatton)
Mawhinney, Dr Brian


Hampson, Dr Keith
Mayhew, Rt Hon Sir Patrick


Hanley, Jeremy
Meyer, Sir Anthony


Hannam, John
Miller, Hal


Hargreaves, A. (B'ham H'll Gr')
Mills, Iain


Harris, David
Mitchell, Andrew (Gedling)


Haselhurst, Alan
Mitchell, David (Hants NW)


Hawkins, Christopher
Moate, Roger


Hayes, Jerry
Monro, Sir Hector


Hayhoe, Rt Hon Sir Barney
Montgomery, Sir Fergus


Hayward, Robert
Morris, M (N'hampton S)


Heathcoat-Amory, David
Morrison, Hon C. (Devizes)


Heddle, John
Morrison, Hon P (Chester)


Heseltine, Rt Hon Michael
Moss, Malcolm


Hicks, Mrs Maureen (Wolv' NE)
Moynihan, Hon C.


Hicks, Robert (Cornwall SE)
Neale, Gerrard


Higgins, Rt Hon Terence L.
Nelson, Anthony


Hill, James
Neubert, Michael


Hind, Kenneth
Newton, Tony


Hogg, Hon Douglas (Gr'th'm)
Nicholls, Patrick


Hordern, Sir Peter
Nicholson, David (Taunton)


Howard, Michael
Nicholson, Miss E. (Devon W)


Howarth, Alan (Strat'd-on-A)
Onslow, Cranley


Howarth, G. (Cannock &amp; B'wd)
Oppenheim, Phillip


Howe, Rt Hon Sir Geoffrey
Page, Richard


Howell, Rt Hon David (G'dford)
Paice, James


Howell, Ralph (North Norfolk)
Parkinson, Rt Hon Cecil


Hughes, Robert G. (Harrow W)
Patnick, Irvine


Hunt, David (Wirral W)
Patten, John (Oxford W)


Hunt, John (Ravensbourne)
Pattie, Rt Hon Sir Geoffrey


Hurd, Rt Hon Douglas
Pawsey, James


Irvine, Michael
Porter, Barry (Wirral S)


Irving, Charles
Porter, David (Waveney)


Jack, Michael
Portillo, Michael


Jackson, Robert
Powell, William (Corby)


Janman, Timothy
Price, Sir David


Jessel, Toby
Raffan, Keith


Johnson Smith, Sir Geoffrey
Raison, Rt Hon Timothy


Jones, Gwilym (Cardiff N)
Rathbone, Tim


Jones, Robert B (Herts W)
Redwood, John


Kellett-Bowman, Mrs Elaine
Rhodes James, Robert


Key, Robert
Riddick, Graham


King, Roger (B'ham N'thfield)
Ridley, Rt Hon Nicholas


Kirkhope, Timothy
Ridsdale, Sir Julian


Knapman, Roger
Roberts, Wyn (Conwy)


Knox, David
Roe, Mrs Marion


Lamont, Rt Hon Norman
Rossi, Sir Hugh


Lang, Ian
Rost, Peter


Latham, Michael
Rowe, Andrew


Lawrence, Ivan
Rumbold, Mrs Angela


Lawson, Rt Hon Nigel
Ryder, Richard


Lee, John (Pendle)
Sackville, Hon Tom


Leigh, Edward (Gainsbor'gh)
Sainsbury, Hon Tim


Lennox-Boyd, Hon Mark
Scott, Nicholas


Lester, Jim (Broxtowe)
Shaw, David (Dover)


Lightbown, David
Shaw, Sir Giles (Pudsey)


Lilley, Peter
Shaw, Sir Michael (Scarb')





Shelton, William (Streatham)
Townend, John (Bridlington)


Shephard, Mrs G. (Norfolk SW)
Townsend, Cyril D. (B'heath)


Shepherd, Colin (Hereford)
Tracey, Richard


Shepherd, Richard (Aldridge)
Trippier, David


Shersby, Michael
Trotter, Neville


Sims, Roger
Twinn, Dr Ian


Skeet, Sir Trevor
Vaughan, Sir Gerard


Smith, Sir Dudley (Warwick)
Viggers, Peter


Smith, Tim (Beaconsfield)
Waddington, Rt Hon David


Spicer, Jim (Dorset W)
Wakeham, Rt Hon John


Spicer, Michael (S Worcs)
Waldegrave, Hon William


Squire, Robin
Walden, George


Stanbrook, Ivor
Walker, Bill (T'side North)


Stanley, Rt Hon John
Walker, Rt Hon P. (W'cester)


Steen, Anthony
Waller, Gary


Stern, Michael
Walters, Dennis


Stevens, Lewis
Ward, John


Stewart, Allan (Eastwood)
Wardle, C. (Bexhill)


Stewart, Andrew (Sherwood)
Warren, Kenneth


Stewart, Ian (Hertfordshire N)
Watts, John


Stradling Thomas, Sir John
Wells, Bowen


Sumberg, David
Wheeler, John


Summerson, Hugo
Whitney, Ray


Tapsell, Sir Peter
Widdecombe, Miss Ann


Taylor, Ian (Esher)
Wiggin, Jerry


Taylor, John M (Solihull)
Wilkinson, John


Taylor, Teddy (S'end E)
Wilshire, David


Tebbit, Rt Hon Norman
Winterton, Mrs Ann


Temple-Morris, Peter
Wood, Timothy


Thatcher, Rt Hon Margaret
Yeo, Tim


Thompson, D. (Calder Valley)
Young, Sir George (Acton)


Thompson, Patrick (Norwich N)



Thorne, Neil
Tellers for the Ayes:


Thornton, Malcolm
Mr. Robert Boscawen and


Thurnham, Peter
Mr. Tristan Garel-Jones.


NOES


Abbott, Ms Diane
Corbett, Robin


Adams, Allen (Paisley N)
Corbyn, Jeremy


Allen, Graham
Cousins, Jim


Anderson, Donald
Crowther, Stan


Archer, Rt Hon Peter
Cryer, Bob


Armstrong, Ms Hilary
Cunliffe, Lawrence


Ashdown, Paddy
Cunningham, Dr John


Ashton, Joe
Dalyell, Tam


Banks, Tony (Newham NW)
Darling, Alastair


Barnes, Harry (Derbyshire NE)
Davies, Rt Hon Denzil (Llanelli)


Barnes, Mrs Rosie (Greenwich)
Davies, Ron (Caerphilly)


Battle, John
Davis, Terry (B'ham Hodge H'l)


Beckett, Margaret
Dewar, Donald


Beith, A. J.
Dixon, Don


Benn, Rt Hon Tony
Dobson, Frank


Bennett, A. F. (D'nt'n &amp; R'dish)
Doran, Frank


Bermingham, Gerald
Douglas, Dick


Bidwell, Sydney
Duffy, A. E. P.


Blair, Tony
Dunnachie, James


Boateng, Paul
Dunwoody, Hon Mrs Gwyneth


Boyes, Roland
Eadie, Alexander


Bradley, Keith
Eastham, Ken


Bray, Dr Jeremy
Evans, John (St Helens N)


Brown, Nicholas (Newcastle E)
Ewing, Harry (Falkirk E)


Brown, Ron (Edinburgh Leith)
Ewing, Mrs Margaret (Moray)


Buchan, Norman
Fatchett, Derek


Buckley, George
Faulds, Andrew


Caborn, Richard
Fearn, Ronald


Callaghan, Jim
Field, Frank (Birkenhead)


Campbell, Menzies (Fife NE)
Fields, Terry (L'pool B G'n)


Campbell, Ron (Blyth Valley)
Fisher, Mark


Campbell-Savours, D. N.
Flannery, Martin


Canavan, Dennis
Flynn, Paul


Carlile, Alex (Mont'g)
Foot, Rt Hon Michael


Cartwright, John
Foster, Derek


Clark, Dr David (S Shields)
Foulkes, George


Clarke, Tom (Monklands W)
Fraser, John


Clay, Bob
Fyfe, Mrs Maria


Clelland, David
Galbraith, Samuel


Clwyd, Mrs Ann
Garrett, John (Norwich South)


Cohen, Harry
Garrett, Ted (Wallsend)


Coleman, Donald
George, Bruce


Cook, Robin (Livingston)
Gilbert, Rt Hon Dr John






Gould, Bryan
Morgan, Rhodri


Graham, Thomas
Morris, Rt Hon A (W'shawe)


Grant, Bernie (Tottenham)
Morris, Rt Hon J (Aberavon)


Griffiths, Nigel (Edinburgh S)
Mullin, Chris


Griffiths. Win (Bridgend)
Murphy, Paul


Grocott, Bruce
Nellist, Dave


Hardy, Peter
Oakes, Rt Hon Gordon


Harman, Ms Harriet
O'Brien, William


Hattersley, Rt Hon Roy
Orme, Rt Hon Stanley


Haynes. Frank
Owen, Rt Hon Dr David


Healey, Rt Hon Denis
Parry, Robert


Heffer, Eric S.
Pendry, Tom


Henderson, Douglas
Pike, Peter


Hinchliffe, David
Powell, Ray (Ogmore)


Hogg, N. (C'nauld &amp; Kilsyth)
Prescott, John


Holland. Stuart
Primarolo, Ms Dawn


Home Robertson, John
Quin, Ms Joyce


Hood, James
Radice, Giles


Howarth,George (Knowsley N)
Randall, Stuart


Howell, Rt Hon D. (S'heath)
Redmond, Martin


Howells, Geraint
Rees, Rt Hon Merlyn


Hoyle, Doug
Reid, John


Hughes, John (Coventry NE)
Richardson, Ms Jo


Hughes. Robert (Aberdeen N)
Roberts, Allan (Bootle)


Hughes, Roy (Newport E)
Robertson, George


Hughes, Sean (Knowsley S)
Robinson, Geoffrey


Hughes, Simon (Southwark)
Rooker, Jeff


Illsley, Eric
Ross, Ernie (Dundee W)


Ingram, Adam
Rowlands, Ted


John, Brynmor
Ruddock, Ms Joan


Jones, Barry (Alyn &amp; Deeside)
Sedgemore, Brian


Jones, Ieuan (Ynys Môn)
Sheerman, Barry


Kaufman, Rt Hon Gerald
Sheldon, Rt Hon Robert


Kennedy, Charles
Shore, Rt Hon Peter


Kilfedder, James
Short, Clare


Kinnock. Rt Hon Neil
Skinner, Dennis


Kirkwood, Archy
Smith, Andrew (Oxford E)


Lambie, David
Smith, C. (Isl'ton &amp; F'bury)


Lamond, James
Soley, Clive


Leadbitter, Ted
Spearing, Nigel


Leighton, Ron
Steinberg, Gerald


Lestor, Miss Joan (Eccles)
Stott, Roger


Lewis, Terry
Strang, Gavin


Litherland, Robert
Straw, Jack


Livingstone, Ken
Taylor, Mrs Ann (Dewsbury)


Livsey, Richard
Taylor, Matthew (Truro)


Lloyd, Tony (Stretford)
Thomas, Dafydd Elis


Lofthouse, Geoffrey
Thompson, Jack (Wansbeck)


Loyden, Eddie
Turner, Dennis


McAllion, John
Vaz, Keith


McAvoy, Tom
Wall, Pat


McCartney, Ian
Wallace, James


McKelvey, William
Walley, Ms Joan


McLeish, Henry
Wardell, Gareth (Gower)


McNamara, Kevin
Wareing, Robert N.


McWilliam, John
Welsh, Michael (Doncaster N)


Madden, Max
Wigley, Dafydd


Mahon, Mrs Alice
Williams, Rt Hon A. J.


Marek, Dr John
Williams, Alan W. (Carm'then)


Marshall, David (Shettleston)
Wilson, Brian


Marshall, Jim (Leicester S)
Winnick, David


Martin, Michael (Springburn)
Wise, Mrs Audrey


Martlew, Eric
Worthington, Anthony


Meacher. Michael
Wray, James


Meale, Alan
Young, David (Bolton SE)


Michael, Alun



Michie, Bill (Sheffield Heeley)
Tellers for the Noes:


Millan, Rt Hon Bruce
Mr. Allen McKay and


Mitchell, Austin (G't Grimsby)
Mrs. Llin Golding.

Question accordingly agreed to.

Bill read a Second time and committed to a Standing Committee, pursuant to Standing Order No. 61 (Committal of Bills).

Mr. Graham Allen: On a point of order, Mr. Speaker.

Mr. Speaker: Order. I cannot take a point of order now.

It being after Ten o'clock, MR. SPEAKER proceeded to put forthwith the Questions which he was directed by paragraph (1) of Standing Order No. 53 ( Questions on voting of estimates &amp;c.), to put at that hour.

Orders of the Day — SUPPLEMENTARY ESTIMATES 1987–88

Resolved,
That supplementary sum, not exceeding £1,196.459.000, be granted to Her Majesty out of the Consolidated Fund to defray charges for Defence and Civil Services which will come in course of payment during the year ending on 31st March 1988, as set out in House of Commons Paper No. 123.

Orders of the Day — ESTIMATES 1988–89 (VOTE ON ACCOUNT)

Question put,
That a sum, not exceeding £47,440,004,000, be granted to Her Majesty out of the Consolidated Fund, on account, for or towards defraying the charges for Defence and Civil Services for the year ending on 31st March 1989, as set out in House of Commons Paper Nos. 94, 104 and 105.

The House divided: Ayes 320, Noes 1.

Division No. 107]
[10.15 pm


AYES


Aitken, Jonathan
Carlile, Alex (Mont'g)


Alexander, Richard
Carlisle, John, (Luton N)


Alison, Rt Hon Michael
Carlisle, Kenneth (Lincoln)


Allason, Rupert
Carrington, Matthew


Amess, David
Cash, William


Amos, Alan
Chalker, Rt Hon Mrs Lynda


Arbuthnot, James
Chapman, Sydney


Arnold, Jacques (Gravesham)
Chope, Christopher


Arnold, Tom (Hazel Grove)
Churchill, Mr


Atkins, Robert
Clark, Hon Alan (Plym'th S'n)


Atkinson, David
Clark, Dr Michael (Rochford)


Baker, Rt Hon K. (Mole Valley)
Clark, Sir W. (Croydon S)


Baker, Nicholas (Dorset N)
Clarke, Rt Hon K. (Rushcliffe)


Baldry, Tony
Conway, Derek


Banks, Robert (Harrogate)
Coombs, Anthony (Wyre F'rest)


Batiste, Spencer
Cope, John


Beaumont-Dark, Anthony
Cormack, Patrick


Beith, A. J.
Couchman, James


Bellingham, Henry
Cran, James


Bendall, Vivian
Currie, Mrs Edwina


Bennett, Nicholas (Pembroke)
Curry, David


Bevan, David Gilroy
Davies, Q. (Stamf'd &amp; Spald'g)


Biffen, Rt Hon John
Davis, David (Boothferry)


Biggs-Davison, Sir John
Day, Stephen


Blaker, Rt Hon Sir Peter
Devlin, Tim


Body, Sir Richard
Dickens, Geoffrey


Bonsor, Sir Nicholas
Dorrell, Stephen


Boscawen, Hon Robert
Douglas-Hamilton, Lord James


Boswell, Tim
Dover, Den


Bottomley, Peter
Dunn, Bob


Bottomley, Mrs Virginia
Durant, Tony


Bowden, A (Brighton K'pto'n)
Evans, David (Welwyn Hatf'd)


Bowden, Gerald (Dulwich)
Evennett, David


Bowis, John
Fairbairn, Nicholas


Boyson, Rt Hon Dr Sir Rhodes
Fallon, Michael


Braine, Rt Hon Sir Bernard
Farr, Sir John


Brandon-Bravo, Martin
Favell, Tony


Brazier, Julian
Fearn, Ronald


Bright, Graham
Fenner, Dame Peggy


Brittan, Rt Hon Leon
Field, Barry (Isle of Wight)


Brooke, Hon Peter
Finsberg, Sir Geoffrey


Brown, Michael (Brigg &amp; Cl't's)
Fookes, Miss Janet


Browne, John (Winchester)
Forman, Nigel


Bruce, Ian (Dorset South)
Forth, Eric


Buchanan-Smith, Rt Hon Alick
Fowler, Rt Hon Norman


Buck, Sir Antony
Fox, Sir Marcus


Budgen, Nicholas
Freeman, Roger


Burns, Simon
French, Douglas


Burt, Alistair
Gale, Roger


Butcher, John
Garel-Jones, Tristan


Butler, Chris
Gill, Christopher


Butterfill, John
Glyn, Dr Alan


Campbell, Menzies (Fife NE)
Goodhart, Sir Philip






Goodlad, Alastair
Lyell, Sir Nicholas


Goodson-Wickes, Dr Charles
McCrindle, Robert


Gorman, Mrs Teresa
Macfarlane, Neil


Gorst, John
MacGregor, John


Gow, Ian
MacKay, Andrew (E Berkshire)


Gower, Sir Raymond
McLoughlin, Patrick


Grant, Sir Anthony (CambsSW)
McNair-Wilson, M. (Newbury)


Greenway, Harry (Ealing N)
McNair-Wilson, P. (New Forest)


Greenway, John (Rydale)
Major, Rt Hon John


Gregory, Conal
Malins, Humfrey


Griffiths, Sir Eldon (Bury St E')
Maples, John


Griffiths, Peter (Portsmouth N)
Marland, Paul


Grist, Ian
Marshall, John (Hendon S)


Ground, Patrick
Marshall, Michael (Arundel)


Grylls, Michael
Martin, David (Portsmouth S)


Gummer, Rt Hon John Selwyn
Mates, Michael


Hamilton, Hon A. (Epsom)
Maude, Hon Francis


Hamilton, Neil (Tatton)
Mawhinney, Dr Brian


Hampson, Dr Keith
Mayhew, Rt Hon Sir Patrick


Hanley, Jeremy
Meyer, Sir Anthony


Hannam, John
Miller, Hal


Hargreaves, A. (B'ham H'll Gr')
Mills, Iain


Harris, David
Mitchell, Andrew (Gedling)


Haselhurst, Alan
Mitchell, David (Hants NW)


Hawkins, Christopher
Moate, Roger


Hayes, Jerry
Monro, Sir Hector


Hayhoe, Rt Hon Sir Barney
Montgomery, Sir Fergus


Hayward, Robert
Morris, M (N'hampton S)


Heathcoat-Amory, David
Morrison, Hon C. (Devizes)


Heddle, John
Morrison, Hon P (Chester)


Heseltine, Rt Hon Michael
Moss, Malcolm


Hicks, Mrs Maureen (Wolv' NE)
Moynihan, Hon C.


Hicks, Robert (Cornwall SE)
Neale, Gerrard


Higgins, Rt Hon Terence L.
Nelson, Anthony


Hill, James
Neubert, Michael


Hind, Kenneth
Newton, Tony


Hogg, Hon Douglas (Gr'th'm)
Nicholls, Patrick


Hordern, Sir Peter
Nicholson, David (Taunton)


Howard, Michael
Nicholson, Miss E. (Devon W)


Howarth, Alan (Strat'd-on-A)
Onslow, Cranley


Howarth, G. (Cannock &amp; B'wd)
Oppenheim, Phillip


Howe, Rt Hon Sir Geoffrey
Page, Richard


Howell, Rt Hon David (G'dford)
Paice, James


Howell, Ralph (North Norfolk)
Patnick, Irvine


Hughes, Robert G. (Harrow W)
Patten, John (Oxford W)


Hughes, Simon (Southwark)
Pattie, Rt Hon Sir Geoffrey


Hunt, David (Wirral W)
Pawsey, James


Hunt, John (Ravensbourne)
Peacock, Mrs Elizabeth


Irvine, Michael
Porter, David (Waveney)


Irving, Charles
Portillo, Michael


Jack, Michael
Powell, William (Corby)


Jackson, Robert
Price, Sir David


Janman, Timothy
Raffan, Keith


Jessel, Toby
Raison, Rt Hon Timothy


Johnson Smith, Sir Geoffrey
Rathbone, Tim


Jones, Gwilym (Cardiff N)
Redwood, John


Jones, Robert B (Herts W)
Rhodes James, Robert


Kellett-Bowman, Mrs Elaine
Riddick, Graham


Kennedy, Charles
Ridley, Rt Hon Nicholas


Key, Robert
Ridsdale, Sir Julian


Kilfedder, James
Roberts, Wyn (Conwy)


King, Roger (B'ham N'thfield)
Roe, Mrs Marion


Kirkhope, Timothy
Rossi, Sir Hugh


Kirkwood, Archy
Rowe, Andrew


Knapman, Roger
Rumbold, Mrs Angela


Knight, Dame Jill (Edgbaston)
Sackville, Hon Tom


Knox, David
Sainsbury, Hon Tim


Lamont, Rt Hon Norman
Scott, Nicholas


Lang, Ian
Shaw, David (Dover)


Lawrence, Ivan
Shaw, Sir Michael (Scarb')


Lee, John (Pendle)
Shelton, William (Streatham)


Leigh, Edward (Gainsbor'gh)
Shephard, Mrs G. (Norfolk SW)


Lennox-Boyd, Hon Mark
Shepherd, Colin (Hereford)


Lester, Jim (Broxtowe)
Shepherd, Richard (Aldridge)


Lightbown, David
Shersby, Michael


Lilley, Peter
Sims, Roger


Livsey, Richard
Skeet, Sir Trevor


Lloyd, Peter (Fareham)
Smith, Sir Dudley (Warwick)


Lord, Michael
Smith, Tim (Beaconsfield)


Luce, Rt Hon Richard
Spicer, Jim (Dorset W)





Spicer, Michael (S Worcs)
Twinn, Dr Ian


Squire, Robin
Vaughan, Sir Gerard


Stanbrook, Ivor
Viggers, Peter


Stanley, Rt Hon John
Waddington, Rt Hon David


Steen, Anthony
Wakeham, Rt Hon John


Stern, Michael
Waldegrave, Hon William


Stevens, Lewis
Walden, George


Stewart, Allan (Eastwood)
Walker, Bill (T'side North)


Stewart, Andrew (Sherwood)
Wallace, James


Stewart, Ian (Hertfordshire N)
Waller, Gary


Stradling Thomas, Sir John
Wardle, C. (Bexhill)


Sumberg, David
Warren, Kenneth


Summerson, Hugo
Watts, John


Tapsell, Sir Peter
Wells, Bowen


Taylor, Ian (Esher)
Wheeler, John


Taylor, Matthew (Truro)
Whitney, Ray


Taylor, Teddy (S'end E)
Widdecombe, Miss Ann


Tebbit, Rt Hon Norman
Wiggin, Jerry


Temple-Morris, Peter
Wilkinson, John


Thatcher, Rt Hon Margaret
Wilshire, David


Thompson, D. (Calder Valley)
Winterton, Mrs Ann


Thompson, Patrick (Norwich N)
Winterton, Nicholas


Thorne, Neil
Wood, Timothy


Thornton, Malcolm
Yeo, Tim


Thurnham, Peter
Young, Sir George (Acton)


Townsend, Cyril D. (B'heath)



Tracey, Richard
Tellers for the Ayes:


Trippier, David
Mr. Richard Ryder and


Trotter, Neville
Mr. David Maclean.


NOES


Wigley, Dafydd
Mr. Max Madden, and



Mr. Graham Allen.


Tellers for the Noes:

Question accordingly agreed to.

Bill ordered to be brought in upon the foregoing Resolutions by the Chairman of Ways and Means, the Chancellor of the Exchequer, Mr. John Major, Mr. Norman Lamont, Mr. Peter Brooke and Mr. Peter Lilley.

Orders of the Day — CONSOLIDATED FUND (No. 2) BILL

Mr. Norman Lamont accordingly presented a Bill to apply certain sums out of the Consolidated Fund to the service of the years ending on 31 March 1988 and 1989: And the same was read the First time; and ordered to be read a Second time tomorrow and to be printed. [Bill 60.]

Mr. Graham Allen: On a point of order, Mr. Speaker. We have just voted through £47 billion of expenditure, plus a further £1 billion on the Supplementary Estimates. According to Standing Order No. 52, it would be in order for the House to refer the expenditure in the Bill to a Select Committee for further consideration.
This afternoon the Leader of the House said that that would not be possible because the Select Committees had not yet been set up. However, under Standing Order No. 53 there is a deadline of 6 February for committing a Bill to a Select Committee. This would allow this third of public expenditure to be properly scrutinised by the Committee and a report to be made to the House on a substantive motion.
Will you, Mr. Speaker, give us your opinion on whether the Standing Orders could still be so interpreted, so that this vast sum, instead of going through on the nod, is properly scrutinised by the House?

Mr. Speaker: The hon. Gentleman knows, because I have told him, that I am bound by Standing Orders Nos.


52 and 53. If this motion is on the Order Paper on any day —and it was on the Order Paper today—I am bound to put the Question at 10 o'clock.

Orders of the Day — HEALTH AND MEDICINES BILL [MONEY]

Queen's Recommendation having been signified—

Resolved,
That, for the purposes of any Act resulting from the Health and Medicines Bill it is expedient to authorise the following—
(1) the payment out of money provided by Parliament of—

(a) any expenses incurred by the Secretary of State in connection with the vesting in the successor company (within the meaning of the Act) of any property, rights and liabilities to which the General Practice Finance Corporation is entitled or subject;

(b) any expenses incurred by the Secretary of State in fulfilling a guarantee or indemnity in respect of a loan made in connection with premises used for the provision of general medical services (within the meaning of the National Health Service Act 1977 or the National Health Service (Scotland) Act 1978);
(c) any sums payable by the Secretary of State by way of compensation under the Act for the removal of a person's name from a list maintained under section 36 of the National Health Service Act 1977 or section 25(2) of the National Health Service Act (Scotland) 1978;
(d) any expenses of a Minister of the Crown attributable to the Act;
(e) any increase attributable to the Act in the sums payable under any other Act out of the Consolidated Fund;

(2) the making of payments into the Consolidated Fund. —[Mr. Darrell.]

Cinematographs and Cinematograph Films

The Parliamentary Under-Secretary of State for Trade and Industry (Mr. John Butcher): I beg to move,
That the draft British Film Fund Agency (Dissolution) Order 1987 which was laid before this House on 27 November, be approved.
The draft order provides for the dissolution of the British Film Fund Agency, once it has completed its outstanding business and, following dissolution, for the application of any surplus moneys of the agency for purposes connected with the British film industry.
The BFFA is the body responsible for distributing the proceeds of the Eady levy on cinema admissions. That levy has already been abolished and the draft order, therefore, is simply a consequential piece of legislation which ties up the resultant loose ends.
As hon. Members will recall, our intention to abolish the levy was announced in the film policy White Paper in 1984, the main aspects of which were subsequently embodied in the Films Act 1985. The purpose of the levy was to recycle money from cinema exhibition to British film production. By 1984 there was almost universal recognition within the industry that it was no longer serving the purpose for which it had been created. It had become a financial burden on what was then a struggling and declining cinema exhibition industry which was providing little money for film makers.

Mr. Bob Cryer: The Minister said that there was universal recognition in the industry that the Eady levy was a burden. Could he say to which section of the industry he was referring? The Association of Cinematographic, Television and Allied Technicians, the National Association of Television, Theatrical and Kinematographic Employees and the Electrical Electronic Telecommunication and Plumbing Union, for example, did not hold that view, nor did the Association of Independent Producers. Several individuals of eminence within the industry felt that the Eady fund was playing a useful purpose.

Mr. Butcher: The hon. Gentleman will have heard me say that the exhibition industry felt most keenly that the levy had not done its best to encourage the increase in cinema attendance. It felt that the levy was an imposition and involved bureaucracy, and that there were better ways of achieving the objective of the levy. I would not contest the hon. Gentleman's interpretation of the trade union views at that time, but I am on fairly safe ground in saying that the levy was universally disliked by the exhibitors.
In view of that, we considered that the levy should be abolished as soon as possible and it was duly terminated from 25 May 1985, almost immediately after the Films Act 1985 came into force. In normal circumstances the levy period would have continued until October 1985.
We recognised, however, that the ending of the levy represented a loss of income to recipients of the funds that it created and, accordingly, provision was made to deal with the impact of abolition on these bodies. Arrangements were made for the National Film and Television School, which received about £500,000 a year

from the levy funds to receive £600,000 annually for five years from the cinemas, the BBC and the independent television companies. We also approved special additional support for the British Film Institute production board, from the final, shortened, Eady levy period.
The other film body that received money from levy funds was the National Film Finance Corporation, which received an annual sum from the levy funds of not less than £1·5 million to enable it to support the production of low and medium-budget British films. As hon. Members will recall, the intention to transfer to the private sector the highly valued work of the NFFC was another of the major strands of our film policy announced in the 1984 White Paper. The Films Act 1985 provided for the dissolution of the NFFC, which took place later that year, and for the provision of annual financial assistance of £2 million for five years to its private sector successor, British Screen Finance Limited. With private sector finance in addition to the Government's funding, British Screen has been operating successfully now for nearly two years.
The remaining recipients of Eady levy moneys were the makers of those British films that qualified to receive payment under the Films (Distribution of Levy) Regulations 1982. Each producer received a proportion of the residue of funds available for disbursement in a particular distribution period after the sums to be paid to the NFFC, the BFI and the school had been subtracted. As the order which terminated the levy reduced the final distribution and levy collection periods from the normal 52 weeks to only 32 weeks, we recognised that producers who qualified to receive payment in respect of that period would clearly suffer a loss of income as a result of the timing of abolition. We decided, therefore, that the net assets of the NFFC, after costs of dissolution had been met, should be passed to the BFFA for distribution to those producers, following which the BFFA itself would be dissolved. Accordingly, section 3(3)(a) of the Films Act enabled the Secretary of State to transfer the surplus moneys of the NFFC to the BFFA, and section 4 provides for the mechanics of disbursement by the BFFA.
The NFFC was dissolved on 30 December 1985. Winding up the affairs of the corporation raised several difficult legal and financial issues which delayed the transfer of its surplus moneys to the BFFA. However, those moneys are now with the BFFA and have been added to those already held by the agency in respect of the final distribution period. The agency has already made an interim distribution to eligible producers and is likely to have completed its final distribution by the end of January 1988.
During the Report stage and Third Reading of the Films Bill, the former Minister with responsibility for films, my right hon. Friend the Financial Secretary to the Treasury, announced that it was the Government's intention that payment would have to be taken up within two months of the final distribution being made. Accordingly, I have decided on a cut-off date of 31 March 1988. This will be widely publicised to ensure that those who are eligible to receive payment know that they will forfeit the money if they do not cash their cheques by that date. I do not expect any problems on that front as the deadline for submitting claims for payment has passed and the procedures for verifying claims have been completed.
Once the cut-off date has passed, the BFFA will pass to the Secretary of State any moneys which have not been cashed, together with any of the moneys set aside to meet


the agency's administrative expenses which have not been spent. Section 3 of the 1985 Films Act provides that those moneys shall be used for any purpose connected with the British film industry. At present, we cannot say how large or small that sum may be, and I cannot say how it will be used. I am sure, however, that there will be no shortage of suitors for it.
Finally, I take this opportunity to pay tribute to the BFFA members and staff. Under their guidance and management, the agency has performed its functions smoothly and effectively. I am sure that hon. Members will join me in expressing appreciation for their work.
I invite the House to support the order.

Mr. Roger Stott: I willingly join the Minister in congratulating the people at the BFFA on the work that they have been carrying out. I only wish that they could continue to carry out their functions. The list of Government policies that have been imposed against the advice of all sides of the film production industry is now very lengthy.
We are debating in the short time allowed to us virtually the last remaining vestige of any Government support for or intervention in the British film industry. We have already seen the abolition of the quota and the Eady levy. We have also seen the abolition of the Cinematograph Film Council and the replacement of the NFFC with the BSFC and the additional uncertainty about the role of screen entertainment and we have seen the phasing out of capital allowances. The order is virtually the final nail in the coffin.
I want to consider the way in which the Government have abandoned their role as the principal architects or partners in funding or helping to fund what in my view and the view of the Labour party is an essential part of British life—the British film industry.
Successive post-war British Governments have introduced measures to give some support to British feature film production. Those measures are replicated in one form or another in most European countries. However, the Government's 1984 White Paper on the film industry, which preceded the Films Act 1985, presented arguments for the dismantling of the existing support for the industry. We have just heard the Minister repeat that this evening. The White Paper stressed the benefits of a free market policy in the film industry and predicted benefits from aspects of that market that were then being stimulated by technical changes such as videos, cable and direct broadcasting by satellite. The assumption was that the new distributive mechanisms would be beneficial to producers as they would expand the market for films. That was a very attractive hypothesis, but one which I believe confused distribution with exhibition.
In the film industry, distribution is a source of finance for production whereas exhibition is a source of revenue following production. However, the new distributive mechanisms are not yet sources of major production finance and are unlikely to be so for the foreseeable future. They will act as consumers of library material of existing films, thereby getting some additional post-cinema revenue, but that is all. They are unlikely, except in the marginal areas, to make any crucial difference in the provision of feature film finance. Only in the United States

are the markets sufficiently developed for pre-sale revenue to be available as a significant element in the production finance.
A year ago the then leading source of film finance in this country, Goldcrest, released three very expensive films — "Absolute Beginners" "Revolution" and "The Mission" two of which received extremely disappointing reviews. The combined effort led to that company virtually withdrawing from production finance for the whole of 1986, with only limited signs of resurgence in 1987. In the same year, 1986, TESE was sold to Cannon which has not been able to live up to its promised commitments to United Kingdom full production finance because it has been plagued by internal financial problems. It has sold the valuable library and there are considerable questions over the future of the studios at Elstree.
It is deeply disturbing that the control of the British film industry has largely passed into foreign hands, particularly given the limited commitment to production shown by the Rank Organisation, the only major British cinema-owning group. That major reduction of finance for film production by leading companies has been mirrored among the smaller backers such as Virgin, United Media and Rediffusion which have also scaled down investments or withdrawn completely from the industry.
The combined effect of the coincidental market shift and Government film policy, has been the virtual collapse of the United Kingdom feature production. Let us consider the years from 1975–85. The average number of feature film starts per year was 49. In 1979, the last year of the Labour Government, the figure rose to the peak of 61. In 1986 that figure had dropped to 37 and this year feature film starts are down to around 10. That is a depressing picture for the British film industry, which has done so well in the past.
The Finance Act (No. 2) 1984 phased out capital allowances. Therefore, by 1985, that Act had stopped the inflow of non-industry money that had become a significant element of the United Kingdom production finance. In 1983 the screen quota was suspended. The Films Act 1985 resulted in the privatisation of NFFC and the Eady levy was phased out. According to the Government's White Paper and the subsequent Bill, those measures were designed to free the industry, but rather than buoying the industry up they have weighed it down. It may be too early to conclude that the present downward trend will continue or will result in a permanent reduction in feature film production, but I am sorry to say that the signs are most discouraging.
I am aware that if my hon. Friend the Member for Stoke-on-Trent, Central (Mr. Fisher) manages to catch your eye, Madam Deputy Speaker, he will endeavour to contrast our efforts with those of the EC and other countries to support their indigenous film industries. Other major European countries have recognised the link between state intervention in the market place and the health of the national film industry. Britain has not. The recent decision not to participate in a European consortium of cinema and television production has isolated Britain from the rest of our EC partners.
The problem that any United Kingdom Government must tackle is how to encourage original United Kingdom production in the face of the unending flow of feature material from the United States. In addition, there are


overwhelming cultural reasons for Britain to keep its own voice in the same way that our European partners have kept their voices in their indigenous film industries.
It is ironic that the current recession that the British film industry is suffering has occurred just when film attendance figures are on the upturn. As a result of initiatives and developments in 1985, the British film year, the number of people who went to the cinema increased between 1984 and 1985 by 11·75 million or 20 per cent. The ground was held last year with a further increase of 2·4 million. Therefore, the Government's argument in the White Paper that the decline in cinema-going was irreversible no longer has a basis in truth or logic. When halls have been refurbished, new pricing policies introduced and multi-screen theatres with car parking facilities and restaurants built, people have wanted to see films in the cinema rather than at home on television. Our production companies will not benefit from the renaissance of cinema-going if we cannot maintain the level of British film production.
A well-developed film policy, which of necessity would include an attitude to television — the two are inextricably linked — must consist of financial and cultural elements. There must be adequate provision for training, and adequate system of support for industrial activity and a constructive mechanism for the bridging of training and professional work.
At present we have various parts of that infrastructure in place. However, what is lacking is an overall policy that permits development and expansion — including job creation—without sacrificing the quality that has been associated with British film and television production.
Talent once developed needs nurturing over an extended period. The top foreign film earner in the United States last year was "A Room with a View", which was developed by the National Film Finance Corporation and financed by a consortium which included the NFFC, Goldcrest, and Channel 4. It demonstrates how an integrated infrastructure can work. The NFFC has assisted Merchant Ivory with previous productions, and has also assisted people such as David Puttnam and many other successful British producers. If the BBC and the ITV companies were allowed, as part of the process of admitting independent producers, to invest funds through the British Screen Finance Corporation, which replaces the BFFA, or a central Government-sponsored film agency, such as a British screen authority, in film production, the risk of destabilisation would be avoided and the British film industry would be underpinned to a significant extent.
The whole question of independent access highlights the problem of the policy emanating from the Minister's own Department and from other Departments. It seems to show a classic degree of non-co-operation in the way in which we support our film industry, because Departments as diverse as Trade and Industry, the Office of Arts and Libraries and even the Home Office are all technically concerned with the film industry. I say "concerned", but I do not believe, on the evidence so far, including what we have heard tonight, that they are really concerned.
I should like to draw the Minister's attention to a document produced by the Association of Cinematograph, Television and Allied Technicians. It organises within the film and television industry and its

members have a great deal of experience. They work in that industry, they are extremely talented and able and they perform a very good job for Britain in the artistic sense. So they can be said to have a vested interest, and I do not doubt that for one moment. What they have been doing for a number of years is putting to Government a creative strategy for the film industry, and what we have seen from the Government is their refusal to consider any of the ACTT's suggestions.
The ACTT has put forward a whole series of suggestions, such as tax concessions, and being able to have 30 per cent. written off during the first year of release, 10 per cent. during the second year of release, 60 per cent. from the commencement of production to first release— a whole range of financial packages which would help stimulate British film production. Unfortunately, the Government have been utterly unreceptive to any of those suggestions.
Government intervention is required if we are to achieve the objectives of an integrated films policy that I have listed. It would not be pouring funds down the drain of an extinct industry to maintain a work force; it would be investing in the expansion of a highly successful one in achievement at all levels of enterprise. The industry is handicapped only by external forces. Such intervention would allow it to reach a plane of stability which it has never reached hitherto. It would enable it to play a most important role as the major proponent of British culture at a mass level, both at home and abroad, with all the export potential that that implies.
My hon. Friends and I and the ACTT are proposing a policy that will dynamically regenerate the British film industry, with enormous benefits not only to the workers in the industry, but to the viewing public as a whole, to the Government and to the country, increasing revenues both at home and abroad, and increasing Britain's status throughout the world.
The British film industry has huge potential. The men and women involved have a highly developed expertise and a worldwide reputation for technical excellence. What we do not have is a Government who are prepared to assist it, and that is a profound disappointment to me and my hon. Friends.

Mr. Bob Cryer: The Joint Committee on Statutory Instruments, which I chair, has drawn the attention of the House to the instrument. I should like to refer to the instrument itself and its merits, and I should be grateful if the Minister would answer my questions when he winds up the debate.
He will appreciate that the Joint Committee does not consider the merits of an instrument, but considers only the powers that the Minister has used.
The House will be interested to know that this is the second order because rather a mess was made of the original order. In our report to the House we say that the current draft contains amendments to articles 1 and 5, to take account of points raised by the Joint Committee on the earlier draft. The date when article 1 came into force was less than clear. Article 5, covering the powers of the Secretary of State in applying the residual moneys, was couched in such a way that it might be thought that the Minister might be able to dispose of the moneys in connection with the British film industry, whereas the legislation requires him to do so. Those points were


recognised and a fresh draft laid. The Joint Committee is grateful to the Minister for taking that action, but it was necessary to do so.
The Minister has close at hand a former member of the Joint Committee, the hon. Member for Dorset, North (Mr. Baker), who appreciates its work and the fact that it is not exactly the most glamorous part of the activities of the House of Commons, but that it is necessary. I hope that the Minister can give us all an assurance that civil servants in his Department will draft instruments in future with more care than in the past.
I should like to refer to the merits of the instruments, but not in the context of the Committee's report. I am sure that the Committee would not want me to give other than my own views about the merits.
It is sad that the order is being presented. It concerns the last vestige of state intervention in the British film industry, which goes back to the 1920s and 1930s. The reason why it goes back that length of time is that the idea of the market place does not work. The biggest market place is the United States. Not surprisingly, the United States film industry dominates that market and gives it a secure home base from which to export to other countries, such as the United Kingdom.
The Interim Action Committee said in 1979:
What should be the object of government policy for films? To stimulate an industry for the normal economic reasons — to create employment, encourage productive investment and increase exports? Or to aid an art form? Or to encourage the making of films which reflect British life? We believe that all three objects are valid. We also believe that the barriers between industry and art in relation to film are largely artificial and subjective, and that government policy should cater for films as a whole.
That committee is saying that it should be regarded as an industry for employment and as one of the major mass art forms that our civilisation has achieved.
In every case it has been recognised over the years that Government intervention, through assistance of one form or another, has been necessary to offset the enormous power of the United States industry, which can invest more in production values and in finding the elusive formula that produces feature film success, as well as to counter the power of the duopoly in the United Kingdom, which the Minister did not mention. The duopoly owns the studios and major exhibition circuits. Rank and Cannon —formerly Thorn EMI—have such commanding power in the industry that if they refuse to show a film it cannot possibly obtain even its costs of production in the United Kingdom. That is why, from the 1930s onwards, it has always been felt that the Government should have some sort of power.
It is sad that the Minister should place such weight on exhibitors only. Exhibitors need the production of films, and the Eady levy was designed to remove some of the revenue from exhibitors, to ensure that there was a continuous production of indigenous British films. The removal of the Eady levy places that in great peril.
The Government are concerned about violence in society, but the private sector will finance films of sex and violence. It will not so easily finance films that reflect the aspirations, the cultural advantages and the development of ordinary people. It sounds rather highbrow, but I am talking about the way of life of our nation. Such films are less likely to meet with favour from the private sector,

which can make a fast buck out of "The Lusty Vicar" and the soft — increasingly hard — porn films that it has financed in large numbers in the past few years.
The policies that the Government have foisted on the industry have been shown in what has happened to Pinewood Studios, for instance. Until recently that was a proper studio, employing 500 people full time and able to sell its services to the rest of the world. It sold them to the United States, for example, for the production of all the Superman films but the last one, which was partly produced at Elstree. The Bond films, too, were made there. The studio provided standards of excellence and production that were unequalled anywhere in the world. Pinewood Studios is now a four-walls operation, in which a handful of people are employed. That means that the apprenticeship system, in which people learnt their craft so as to provide those standards of excellence, has been eroded at one fell swoop because of the uncertainty engendered by Government policies.
It is ironic that a visit by the Parliamentary Labour party films industry study group in 1983 received assurances from Pinewood management about providing an employed service, which film producers found of advantage because that employed staff represented the level of crafsmanship that had gained an enviable reputation throughout the world. The National Film Finance Corporation provided finance for films that might otherwise have been lost. They included "Gregory's Girl", a runaway financial success, produced for £350,000, about a local lad in a modern town in Scotland going to a local comprehensive school. What sort of private sector entrepreneur would respond if presented with that sort of script? He or she would reject it out of hand, but the film was an enormous success. It made a great deal of money and brought credit to British film producers and the British film production industry.
The National Film Finance Corporation is now defunct, as the Minister correctly said. The order winds up its residues. However, it produced controversial films such as "Britannia Hospital", "Local Hero", "Babylon" and a whole range of films, including "The Europeans", which was a cultural landmark. Although it did not receive big audiences, it was still an important production. All that has gone.
The Eady levy was successful—not completely, but to some extent—in eradicating the problems that genuine film producers who wanted to make films about our way of life faced in obtaining money so to do. The "Hot Wheels" syndrome was eradicated by the publication of the Eady levy returns when my hon. Friend the Member for Oldham, West (Mr. Meacher) was at the Department of Trade and Industry. That meant that producers could no longer add rather mediocre shorts to successful feature films and buy up the Eady returns in advance.
That was the "Hot Wheels" syndrome. I do not have time to go into the details, but "Hot Wheels" was a modest production about skateboards and it earned a lot of money because it was coupled with a good feature film. Publishing the returns and putting an upper limit on the amount of Eady money that could be earned on a film helped to eradicate some of the problems.
The Minister says that he will spend any residual amounts on purposes connected with the British film industry. Will he spell out in a little more detail what that means? He may have some money in his hand, but if, because of his policies, he were to launch a gigantic wake


for the British film industry, that would be purposes connected with the film industry. I hope that he has the serious intention of helping British film producers and that he will provide seed money for scripts. Perhaps he could help the National Film School or do something like that. I am sure that he will say something about what the money should be used for.
This is a sad debate, but I am sure that the British film industry has a residual will to survive. It is an important mass art form, both in its theatrical form and in satisfying the voracious appetite of television. After the next general election the Labour Government will have a policy to ensure that British films about our people will continue to be made.

Mr. Menzies Campbell: I shall not detain the House because many of the observations that I would have made have been forcefully made by other Opposition Members. It cannot be contentious that the British Film Fund Agency falls to be dissolved by this order, because that is a necessary consequence of the abolition in 1985 of the Eady levy. In the last few minutes that levy has enjoyed some support, but prior to its abolition it is fair to say that, at least in some quarters, it had become discredited. Criticisms had been advanced against it that frequently most money went to films that already had substantial earnings and that frequently money went to foreign companies that qualified by using British casts, crews and facilities.
It is contentious that nothing effective has been put in place of the Eady levy which in 1983–84 raised about £4ô6 million. On the figures of the Department of Trade and Industry, investment in the United Kingdom's film industry fell by about 20 per cent. between 1985 and 1986. It is no understatement to say that now the United Kingdom film industry is in a critical condition. It is an important industry that employs over 20,000 people, and it contributes substantially to export earnings. Perhaps more than that, it plays a central role in our cultural life, both popular and, perhaps, exclusive. It is an important measure of how we and our society are seen abroad. In recent years the successes of British films and British film makers, of whom Mr. Bill Forsyth is but one, are eloquent testimony to that.
The support that the Government presently offer to the British film industry is poor in comparison, for example, with France where the annual amount is £30 million, Italy where it is £26 million, and Canada where it is £16 million. There is an urgent need for the Government to take action to preserve the United Kingdom industry. Any funds that may be realised as a result of the effects of article 5 of the order will hardly be sufficient for that purpose.
A number of measures might be considered. First, there should certainly be stronger and effective action against piracy. Secondly, further consideration sho:uld be given to a levy on blank video tapes, the proceeds of which could be used to assist our film industry. Perhaps more substantial and more radical, it is time for a thorough rethink on the nature of Government support for the United Kingdom's film industry. If those or similar measures are not swiftly taken, irreparable damage may be done. The Government have an obligation to act now, before it is too late.

Mr. Chris Smith: When the Films Bill was being debated in 1985, some hon. Members warned the Government of the likely consequences of the abolition of the Eady levy and the abandonment of any realistic support for the production of British films. Sadly, those warnings are now being proved correct. The Minister, in his opening of the brief debate, emphasised that the exhibitors were in favour of the abolition of the Eady levy. They would have been, as it was a levy on their takings. During the passage of the Films Bill, the entire production section of the industry — not just the trade unions, but producers and managers—banded together and, in a unique statement, condemned the Government for their proposals to withdraw all support for the production of film. It is sad that the predictions made at the time are now beginning to come true.
The year 1986 was one of the worst ever for British film production. According to Screen International, only 37 theatrical features were made in 1986, compared with 55 in 1985 and an average of 48 over the past decade. There is only a slight improvement in 1987. The seed money generated by the activities of the various organisations charged with distributing the Eady levy, which acted as a catalyst for private enterprise to seize the initiative and take off on production, is now no longer there.
It behoves the Government, now that we are in the closing stages of their support for British films, to start thinking about what will be put in its place. If nothing is put in its place and the Government rely entirely on the private sector, which seems to be their intention, I do not see any future renaissance for the production of British films, no matter how much talent, enthusiasm and desire for production may exist.
The old nitrate film stock, which exists at the moment, may not exist for very much longer. Before 1952 much film was made on nitrate stock, which deteriorates. If the film is not copied on to safety stock, it will be gone for ever. Much of our history and heritage is contained on film taken before 1952, which has not yet been copied on to safety stock from nitrate. During the passage of the Films Bill I asked the Government to take this problem seriously and to establish a scheme of support to save the film on nitrate, but they refused to take up that issue.
The Nitrate Project 2000 has now been established, on a cross-industry basis, which is making the Government and the private sector aware that only 13 years are left in which to save the existing deteriorating and highly unstable nitrate stock. The cost of saving it will be about £13 million —£1 million a year — and in terms of Government expenditure that is not such a great deal. That expenditure would save much of our heritage, history and tradition. It would save much of the wealth of the early years of British film making.
I hope that the Government will take this initiative on board. I hope also that they will respond positively to the proposals that are being made by those who are involved in the Nitrate Project 2000. If the Government cannot see a way of using any of the residue of the Eady levy for such a purpose, they might consider other possibilities. For example, they could use a greater proportion of the national heritage memorial fund than hitherto to support the saving of nitrate stock. The Minister might persuade his right hon. Friend the Chancellor of the Exchequer to


bring forward proposals in the Budget for tax deductibility for support for the saving of nitrate film stock. There are mechanisms available to the Government, which I hope that they will use, to save that which is part of our heritage.
If, by introducing this measure, the Government cannot support the future of the British film industry, and it would seem that they do not want to do so, perhaps they can play some part in saving its past.

Mr. Roger Gale: I had not intended to intervene in the debate this evening. However, having been a member of the Committee that considered the Films Bill 1985, and having heard certain comments made this evening, I wish to make a contribution slightly longer than you would tolerate in the form of an intervention, Madam Deputy Speaker.
When we discussed these matters in Committee in 1985, it was clear that exhibitors wanted the Eady levy abolished. As my hon. Friend the Minister has said, from the other side of the Chamber we hear the cry, "They would, wouldn't they?" It was the small, independent exhibitors, not those who have been referred to as the big two this evening, who wanted the levy to be abolished. That was their wish because it was placing a tremendous burden upon their margins.
Had any Opposition Members been present late at night a couple of weeks ago—they with their burning interest in the industry — they would have heard a discourse between my hon. Friend the Minister and myself on film exhibition. They would have heard my hon. Friend commit himself and his Department to a review of the barring contract. They would have heard him say also that by the end of January the matter would be resolved, with the result that many more small, independent cinemas would be able to show many more films. It is the outlet for such films—small films that used to be supported by a subsidy—that is so important. It is that which has been denied to them.

Mr. Mark Fisher: Will the hon. Gentleman give way?

Mr. Gale: I trust that the hon. Gentleman will make his own speech. I shall not give way. I have only a little more to say.

Hon. Members: Give way.

Mr. Gale: No, I shall not give way. I am sure that the hon. Member for Stoke-on-Trent, Central (Mr. Fisher) will wish to make his own speech.
I wish to develop my argument slightly further —[Interruption.] I am sorry that the hon. Member for Stoke-on-Trent, Central finds it unpalatable. I thought that he might.

Mr. Fisher: Will the hon. Gentleman give way?

Mr. Gale: No, Madam Deputy Speaker, I am not giving way. I hope that I have made that clear.

Madam Deputy Speaker (Miss Betty Boothroyd): The hon. Member for Thanet, North (Mr. Gale) has made it clear that he is not giving way to the hon. Member for Stoke-on-Trent, Central (Mr. Fisher).

Mr. Gale: When we discussed these matters in considering the Films Bill 1985, some of us, including my hon. Friend the Member for Richmond and Barnes (Mr.

Hanley) and I, suggested that one possibility might be a levy imposed on the films shown on television. We felt strongly that although the Eady levy was placing an intolerable burden upon the independent exhibitor, it was raising only little money. The hon. Member for Rugby (Mr. Stott) has referred to the Association of Cinematograph, Television and Allied Technicians. I am glad that he did so. I believe that I am the only paid-up member of the ACTT in the Chamber this evening. I do not recall the ACTT making any proposals to abolish the restrictive union practices that destroyed the British film industry. Not only that, but I do not recall the ACTT lending its weight to our suggestion that there should be a levy on films shown on television, the money from which would go to independent production. The reason is that the ACTT has a vested interest in in-house productions made by the major television companies.
Some common sense had been spoken on both sides of the House this evening. However, I suggest that any pretence that the Eady levy was making any realistic contribution to film production in this country when we decided to abolish it, or that it was doing the film distribution industry, in terms of the independents, any good, is sheer humbug.

Mr. Tom Clarke: The House would have been spared humbug in tonight's debate, had it not been for the speech that we have just heard. I, too, was a member of the Standing Committee in 1985, and I do not recall— [Interruption.]

Madam Deputy Speaker: Order. The hon. Member for Monklands, West (Mr. Clarke) has the Floor.

Mr. Clarke: You are absolutely right, Madam Deputy Speaker. If this were a cinema, people would be stamping their feet because of the problems with the sound quality.
I, too, was a member of that Standing Committee, and I do not recall vicious attacks on the trade union movement — even from his hon. Friends — of the sort that the hon. Member for Thanet, North (Mr. Gale) has just made. Nor, when we think of the real crisis in the British film industry, and when we hear of criticisms from producers such as David Puttnam, can we put our hands on our hearts and say—for instance—that when he fled to America he blamed the trade unions. He did not: he blamed the Government. He said that they were not providing the financial incentives, and he was right. The order that we are debating tonight underlines that view.
Perhaps I should have declared an interest at the start of my comments. I am an unpaid governor of the British Film Institute, and for many years I was an assistant director of the Scottish Film Council — although, in truth, I was not paid all that much more there! Tonight, I should like to say a word or two about some of the points made by my hon. Friends.
My hon. Friend the Member for Wigan (Mr. Stott) made an excellent speech, as did my hon. Friends the Members for Bradford, South (Mr. Cryer) and for Islington, South and Finsbury (Mr. Smith). My hon. Friend the Member for Islington, South and Finsbury also served on the Standing Committee.
I should like to take up two points. One is the issue of training, which I think is crucial. Secondly, the Government have no strategy for the British film industry.


Because of that we are facing many problems, not least in Scotland. Some of those were mentioned by the hon. and learned Member for Fife, North-East (Mr. Campbell).
This debate is important, and it is particularly important at the present time, when the Scottish Office is apparently considering seriously the amalgamation of the Scottish Arts Council and the Scottish Film Council. I know—and I am sure that my hon. Friend the Member for Stoke-on-Trent, Central (Mr. Fisher) will agree—that very few people in Scotland consider that there is any merit in that proposal. I am glad that the Minister of State, Scottish Office is present, and I hope that he will convey my views to his ministerial colleague the Parliamentary Under-Secretary of State, the hon. Member for Stirling (Mr. Forsyth). The Scottish Film Council would be smothered, and would not be free, for example, to fight for proper training within Scotland.
As this instrument refers to the right of the Secretary of State for Trade and Industry to deal with surplus funds, we should remind the Government that some of those surplus funds could reasonably be spent on training, and might be invested in the National Film and Television School. In spending the money in that way, the Secretary of State might remember—let me put it gently but firmly—the discrimination against Scottish students that is taking place at present. That is not because the National Film and Television Council wishes it, but because honours graduates in the United Kingdom outside Scotland are able to complete their studies after three years. However, the Scottish course lasts for four years. Scottish students are thereby penalised during the first year of their studies at the National Film and Television School. For all students, their last two years at the school are considered to be part of the postgraduate course. Why should Scottish students be discriminated against?
The hon. and learned Member for Fife, North-East (Mr. Campbell) referred to Bill Forsyth. Ministers and Conservative Members pay tribute, quite rightly, from time to time to "Gregory's Girl", "Comfort and Joy" and "That Sinking Feeling" among other films from Scotland. I pay tribute to Mike Alexander and Charles Gormley who produced "Heavenly Pursuits", despite the fact that there is discrimination against Scottish students. We ought to fight so that the potential of every young man and young woman throughout the United Kingdom can be realised. There might be a young man or a young girl in Benbecula, Glasgow, Edinburgh or Coatbridge who has the same potential as those successful film-makers. We have no right to stand in their way. Unhappily, this Government's policy is reflected in the decisions of the Scottish Education Department. It has the discretion to contribute to the first year of study but it has refused to use its powers to do so.
I initiated an Adjournment debate on the film industry on 25 May 1984. The present Secretary of State for Education and Science used words that are now part of the mythology that is connected with the film industry. He said:
It is not too much of an exaggeration to describe it as a renaissance."—[Official Report, 25 May 1984; Vol. 60, c. 1409.]
We have heard of the so-called renaissance of the British film industry, but what is the truth of the matter? The truth is that after the passing of the 1985 Act the Government's

policy has been absolutely disastrous. My hon. Friends have reminded the House of what happened to Goldcrest and Pinewood Studios after the abolition of the Eady levy.

Mr. Jeremy Hanley: How many cinemas were there then? How many are there now?

Madam Deputy Speaker: Order. If the hon. Member has something to say he should rise and seek to intervene.

Mr. Clarke: Yes, Madam Deputy Speaker, especially as the hon. Member appeared to be making a valid point. He is not always so modest. He referred quite rightly to the decline in cinema audiences. There has recently been a small increase, but since the war there has been a dramatic reduction in cinema audiences.
In Committee we argued that the principle of the Eady levy was right, but many hon. Members would have no objection to change. The levy was introduced to encourage those who enjoy films to make a contribution to the producers that they could make even better films. If that principle were to be applied to today's use of films, television would make a sizeable contribution. We should also consider the impact of video films. Very few newspapers now have a film column, but all of them have a video column. Those who are using video films should be asked to make a contribution to future investment and future productivity.
The hon. Member for Thanet, North (Mr. Gale) forgot to remind the House that his hon. Friend the Member for Hendon, North (Mr. Gorst) persuaded the Committee to accept the introduction of such a levy.

Mr. Hanley: indicated assent—

Mr. Clarke: I am glad that the hon. Gentleman agrees.
The Committee agreed, but when it came before the House on Report the Government used their majority to vote down the logic of that argument.
The truth is that, far from the expanding film industry that the right hon. Member for Mole Valley (Mr. Baker) had promised the House, we are witnessing an unnecessary decline. That decline is tragic and worrying because the fall in investment, and in the commitment to free enterprise in the film industry — even when it is not succeeding—betrays the tremendous talent and ability that we have in Great Britain among producers, those who work the cameras and actors and actresses.
That is a tragedy and the British people will not let the great variety of talent in our film industry be squandered. In the meantime however, that talent is being betrayed by a Government whose idealism and commitment to the free market does not reflect that talent. That is a betrayal of the British film industry.

Mr. Mark Fisher: As my hon. Friends have eloquently said, this is a black Monday for the British film industry. In winding up the British Film Fund Agency, we are leaving our film production industry without any form of Government support. The House will understand that the Minister has not held his responsibilities for very long, but the House will have been amazed and depressed by the complacency with which he introduced the order and the lack of historical perspective in which he put it. He did not seem to understand the significance of what we are deciding. He did not seem to understand that my hon. Friend the Member for Wigan (Mr. Stott) made clear in his trenchant speech—I hope


that the Minister listened to him—that this was the last of the stripping away of all Government support. The quota has gone, the Eady levy has gone, the capital allowances have gone and all tax incentives have gone. They have all finished and our British film industry is left with absolutely no support.
Our quarrel is not with the removal of all those specific forms of assistance. I have some sympathy with the comments of the hon. Member for Thanet, North (Mr. Gale)—and my hon. Friend the Member for Bradford, South (Mr. Cryer) who said that there were imperfections with the Eady levy. I suspect—no, I am certain—that I am the only hon. Member to have been a beneficiary of the Eady levy. I know very well that the films with which I was able to benefit were possibly not as distinguished artistically, or in any other way, as some of the films that have benefited from the levy. The "Hot Wheels" system, to which my hon. Friend the Member for Bradford, South referred, saved some small producers, such as myself, and allowed us to go on to make other films. It was by no means a perfect system. We recognise that, and my hon. Friend with his great experience and knowledge of the industry, put that into a clear perspective.
If we are withdrawing all forms of support, it is important that there is some other way in which the country recognises the importance of the industry and gives it some financial assistance. However, the Government are neglecting it because of an ideological commitment and determination to the concept of the free market. In this industry, in which our small production base must compete with the United States' north American production base, there is no free and equal market.
The Minister told the House that the only support that the Government now give the industry is £1·5 million to British Screen and support through his right hon. Friend the Minister for the Arts for the excellent National Film School. It is not surprising that, with that level of support, and contrary to what my hon. Friend the Member for Bradford, South suggested, investment is declining catastrophically. Whereas production was held at about £300 million in 1985 and 1986, it looks likely to be down to only £115 million this year.
The decline is accelerated by the Government's fiscal policies. Indeed, they have perhaps been the crucial element in the devastation of our industry. If the Minister can understand only one thing as a result of this debate, it should be the significance of the Chancellor's fiscal policies and their destructive effect on the British film industry through withdrawal of capital allowances, his exchange rate policy and through withholding tax.
The Finance Act 1984 ended 100 per cent. capital allowances. We went to a cost recovery system, which made it possible to recover only 75 per cent. of the cost of a film over five years. The Minister may maintain that that does not make any difference because the receipts from films usually come in slowly. He should understand that "A Room with a View" grossed £70 million in the first six months. He may say that that proves that it is possible to recover the money quickly, but if he takes the trouble to ask British Screen, he will understand that it was an equity investor in "A Room with a View" and was not paid for two years.
The abandonment of capital allowances has made an enormous difference to investors and producers. The Chancellor has thus done a disservice to the industry, but

the effects of that are not perhaps as great as those resulting from the imposition, from 1 May 1987, of witholding tax. There was no consultation with the industry and there is confusion about how it will work. In the first six months of operation, it is clear that film companies are not coming here because of uncertainty about our Inland Revenue. It is clear that it is not worth their while coming here. It is not worth important cameramen, producers, directors and actors risking battling with and perhaps falling foul of the Inland Revenue. That process is hardly helped by the Chancellor's new foreign entertainers unit of the Inland Revenue not understanding what it is doing or, if it does understand, applying the rules extremely harshly. There is no fiscal uniformity with other territories. We have a far harsher regime than any other territory.

Madam Deputy Speaker: Order. Now that he is talking about other territories, the hon. Gentleman is going very wide of the order. Perhaps he will bring his remarks back to the subject of the debate.

Mr. Fisher: I apologise. I was trying to impress on the Minister the importance of his understanding that some form of assistance is needed. If we persuade him of that, he may reconsider the order.
As my hon. Friend the Member for Wigan said, other territories provide support such as the Minister is withdrawing by winding up the BFFA. It is possible to amortise a film by 70 per cent. in one year in France; by 90 per cent. in the first year and to write off from the second year on in West Germany and by 100 per cent. in the first year in southern Ireland. We could continue through Europe. Every other country has fiscal incentives to write off losses. We simply do not have the facility.
The alternative to fiscal assistance is direct investment, but the United Kingdom is withdrawing that form of support, too, and replacing it with nothing, thus leaving us disadvantaged. We put £1·5 million into British Screen. Australia invests more than £18 million, Canada more than £17 million and West Germany £15·7 million a year. Spain, in an interesting combination of fiscal and direct investment at both regional and national levels, invests well over £20 million a year to the benefit of its industry. France, again in a curious combination of incentives, guarantees and deductions, invests more than £70 million a year. I ask the House to contrast that with our £1·5 million a year, at a time when audiences are increasing and the industry has the skills and the production expertise.
The hon. Member for Thanet, North sought credit and referred to his recent Adjournment debate. I pay tribute to him for his skill in raising the debate on barring. But he should understand that the Minister is not yet following up the recommendations of the report; I wish he were. The letter makes it clear that submissions are requested between now and the end of January and I hope that at that stage the hon. Gentleman will give full backing to the ending of the barring system because the whole industry would benefit. I am sure that the hon. Gentleman understands that that is not what the Minister is saying; the Minister is being indecisive. I hope that, together, the hon. Gentleman and I can encourage the Minister to press on with that.
We are not meeting to bury the BFFA; we are here to bury the British film industry, which is a far more serious matter. The collapse from £300 million a year production


to £115 million in the first year of the new regime is a disaster. Add to that the exchange rate between the dollar and the pound, and withholding tax and we are seeing the fast decline, indeed death, of our film industry.
The Minister is new. He will learn. I urge him to read the BFTPA's report on fiscal incentives, to talk to independent producers, not just in the exhibition industry, but throughout the industry, and to listen to what they say about the realities of tax incentives, withholding tax and the lack of Government support. If he listens and learns, he may join us in trying to persuade the Chancellor of the Exchequer that his obsession with fiscal neutrality and uniformity will be the death of the industry. If he does not persuade the Chancellor, the industry will die.

Mr. Frank Haynes: The Minister is a little anxious, but I assure him that I shall not take long. I apologise for having spoken in the Chamber twice today, but I feel that I must speak on this subject. I know that I am getting on in years—[HON. MEMBERS: "Hear, hear."]— but I have been interested in the silver screen since I was a lad and that interest has continued year on year.
This evening's story has been about what is happening to the British film industry. It is tragic, bearing in mind our genuine interest in the industry, and I speak, not merely more for myself, but for other hon. Members. The hon. Member for Richmond and Barnes (Mr. Hanley) has appeared on the silver screen. His father made a marvellous contribution to the British film industry, as did my hon. Friend the Member for Warley, East (Mr. Faulds), who usually sits at the back of the Chamber making a bit of noise sometimes.

Mr. Hanley: The hon. Gentleman should not forget my mother.

Mr. Haynes: I must not forget the hon. Gentleman's mother. In this speech I shall not mention the Under-Secretary of State for Health and Social Security, the hon. Member for Derbyshire, South (Mrs. Currie). I often talk to my hon. Friend the Member for Warley, East, because many of his films appear on Channel 4. That was the real British film industry, but over the years it has deteriorated. It is tragic. I wish that I had some power to do something about it, because I am very worried about what is happening.
My hon. Friend the Member for Jarrow (Mr. Dixon), who is also interested in the British film industry, and I joined my hon. Friend the Member for Bradford, South (Mr. Cryer) in the parliamentary film group. We visited many studios and met many actors, and we have seen the studios fall by the wayside because the industry has been run down. A few years ago we visited Pinewood and met Albert Broccoli, who produces the "007" films. He said, "I will play my part in saving the British film industry", and he has kept his word. Had it not been for him, Pinewood would have closed by now.
I cannot understand why the Government have not grasped the nettle. They know that the industry is being run down and that it will soon be producing only B films. Following that will be the complete closure of the British film industry if we are not careful.
Britain produces the finest actors in the world—

Mr. Don Dixon: In here.

Mr. Haynes: My hon. Friend is right, but we are losing those actors to America. Training in the industry is also falling by the wayside. The rundown in the film industry means that training too must go. They go together. With the little training that will be available, all that we will be doing is producing actors and technicians for the Yanks. In the coal industry, where I worked for many years, we trained electricians and fitters who flitted over to private industry after public industry had paid for all their training. The same will happen in films.
In a previous debate on films I named the actors who had left our shores for America and filled their pockets with gold over there, at the expense of British films. However, many British actors stood by the British film industry and made some marvellous films. I want to see the day when the British film industry does that again.
The industry is running down and cinemas have closed right, left and centre across the whole country, but slowly and surely they are re-opening. We must give them support. They must come back. We need the film industry to grow back to what it was. It must grow so that it can provide more of the kind of entertainment that I have enjoyed for many years, especially when I was a young lad.

Mr. Butcher: With the leave of the House I will reply to this debate.
There is no lack of unanimity in the Chamber tonight that we all want to see a healthy British film industry and a healthy British production side to that industry. I very much enjoyed the tour d'horizon of the hon. Member for Stoke-on-Trent, Central (Mr. Fisher). However, he went a little too far when he implied that the ending of a defunct levy through the BFFA would mark, to paraphrase the hon. Gentleman's comments, the death knell of the British film industry. That is surely not the conclusion to which the hon. Gentleman wanted to lead us when he began his speech. Perhaps we should understand that the hon. Gentleman's rhetoric got the better of him and that the excellent analysis in the earlier parts of his comments did not lead to an appropriate conclusion when he went over the top in the way that he did.
The abolition of the Eady levy can be used to prove anything. If one were to take an exclusive set of phenomena and apply a particular conclusion to them one could state that while the Eady levy was applied, attendances went down, and since it has been abolished attendances have been moving upwards. I do not claim that the trend occurred simply because the levy was or was not there. However, Opposition Members have overplayed the levy's role. I want to show, in the few moments available to me, that not only have they over-played the levy's role, but that there were a number of major errors in fact when they implied that there was no help for the industry in training—and that is a very important issue— or by way of production support, whether one is talking about the so-called artistic section of the industry or that part of the industry referred to with a capital "I". The dichotomy was debated by Michael Winner recently as the debate between the "gentlemen and the players".
For the record I should state that my Department gives support for the screen film industry through British Screen Finance Limited by providing, as was accurately reported by Opposition Members, an annual grant of £1·5 million for five years for the production of medium and low budget films, and a further sum of £500,000 each year for


project development work and the production of short films. With that financial support, British Screen has been able to invest in 18 feature films, 13 short films and support 19 applications for project development assistance in less than two years. I have a selection of the films so supported and I am bound to say that they reflect a variety and quality that anyone interested in the cinema would find wholly commendable.
The Government also provide assistance to support the artistic and cultural aspects of films. My right hon. Friend the Minister for the Arts who has been in his place throughout the debate has recently announced a three-year programme of arts funding which will result in increases of about 50 per cent. for the National Film and Television School over three years — the sums being £1·;13 million rising to £1·7 million, an increase of nearly 20 per cent. for the BFI over the same period, rising from £10·03 million to £12 million.
I cannot accept that the commercial film industry needs wholesale subsidy in spite of a fall in exports for British films from £260 million in 1985 to £209 million in 1986. Our overall export performance in films has remained strong in recent years. That is primarily due to the widely acknowledged—it is recognised on both sides of the House — excellence of our film-making talent coupled with the industry's continued ability to make films that sell overseas. The English language confers a major advantage to British film-makers in the important North American market.
I have had discussions with most parts of the film industry—the distributors, exhibitors, producers, studios or whatever—and I have thoroughly enjoyed meeting those various representatives. It is to the credit of all of them that they have focused on the production question. A number of common themes emerged when representations were made to me. Let me say straightaway that even without the hon. Gentleman's seminar—

Mr. Stott: Which one?

Mr. Butcher: I am referring to the seminar given by the hon. Member for Stoke-on-Trent, Central. I shall come to the seminar of the hon. Member for Wigan (Mr. Stott), which was equally enjoyable, in a moment.
I accept that the question of the withholding tax does cause a difficulty. Without prejudging the issue, that will be one of the items of discussion that my right hon. Friend the Minister for the Arts and will have with our right hon. Friend the Financial Secretary to the Treasury.
I understand that the difficulty is that agents on the east and west coasts of the United States may be tempted to say to some of their leading artists that they should not go to the United Kingdom because they may be liable to a taxation rate of up to 60 per cent. The hon. Member for Stoke-on-Trent, Central and I know that the withholding tax is levied at the rate of about 27 per cent. When difficulties arise or clarification is required, a unit, set up within the Inland Revenue, does its best to deal with anomalies or any lack of certitude that may cause visiting American artists reason to feel uncomfortable or nervous.
I wish to satisfy myself that the current system is working correctly. In my discussions at the Treasury I will also seek ways to re-introduce some incentives for the British production industry. The hon. Member for Stoke-on-Trent, Central will understand that, tonight, I cannot debate with him what my comments may be in any subsequent conversations. We are agreed that the fall in production is significant. We are agreed to try to find ways to encourage the reversal of that trend. However, I believe that the hon. Gentleman and start from different philosophical and practical premises. I am not prepared to go to see my right hon. Friend at the Treasury and say that we want to introduce industry-specific schemes. That has not been the thrust of my right hon. Friend's policies in the past few years. I have no intention to try to persuade my right hon. Friend to reverse that policy trend. In the past, industry-specific schemes, no matter what the industry, have tended to feed on themselves and produce more and more anomalies.

Mr. Fisher: Will the Minister confirm that all the people he has spoken to on the production side of the industry have told him that every other country in Europe has industry-specific tax incentive schemes and that the Government are leaving our industry at a fiscal disadvantage compared with other territories?

Mr. Butcher: In answer to the exact terms of the hon. Gentleman's question I cannot confirm that they said that every other European country operates positive discrimination, that is industry-specific. I can confirm that there is a great deal of concern about the level of production. However, the analysis of cause and effect is something that we could debate for a long time.
For example, the hon. Gentleman mentioned the movement of currency. If, for example, I am a big American production company and I am looking at the blandishments which are now coming in from places like Mexico, Spain, Canada and every state in the United States, all shopping for film production work, offering incentives and so on, could the hon. Gentleman tell me —and I am not inviting him to intervene—for example, the impact of the movement in the dollar against the pound, compared with, say, the removal of capital allowances, when one is looking at a location on which one wishes to produce a major film? It is excruciatingly difficult to extract from all the representations made to me those which are, firstly, within my power to do something about and which are significant and, secondly, those which are not. I suspect that anyone standing at this Dispatch Box tonight, or the previous films Ministers, will have gone through exactly those same dilemmas.

It being one and a half hours after the commencement of proceedings on the Motion, MADAM DEPUTY SPEAKER put the Question, pursuant to Standing Order No. 3 (Exempted Business).

Question agreed to.

Resolved,
That the draft British Film Fund Agency (Dissolution) Order 1987, which was laid before this House on 27th November, be approved.

Offshore Fabrication Industry (Scotland)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Neubert.]

12 midnight

Mr. Henry McLeish: I am pleased to have an opportunity to bring to the Floor of the House the important question of the crisis facing the North sea oil construction industry in Scotland.
It would be easy merely to criticise the Government's industrial record in Scotland, which is appalling and shows little sign of improving. It would also be easy in this type of debate to concentrate on the construction yard in my own constituency, RGC Offshore in Methil. But I should like to widen the debate and talk about the crisis facing the whole industry in Scotland. That embraces seven major construction yards, which are facing immense difficulties. They are Highlands Fabricators, Kestrel Marine, Lewis Offshore, McDermotts, RGC, Scott Lithgow and UIE Scotland.
It is often said that winning oil from the North sea is very difficult in such a hostile environment, but increasingly in Scotland winning work related to North sea activity is also becoming very difficult in the kind of hostile environment that the Government are creating. Before getting into the substance of the debate, I should like just for a moment, to take hon. Members about 400 miles from here to my constituency on the shores of the Firth of Forth, where, in Methil, we have a major construction yard.
Just to give hon. Members some indication of the type of project that we are talking about, let me give the dimensions of the order currently being constructed in that yard. It is a £52 million contract for the fabrication of a jacket for the Tern oilfield which has been placed by Shell and Esso. To illustrate the scale of such ventures, this jacket will weigh 21,500 tonnes, it will be 587 ft high, its base will measure 328 ft by 262 ft and at the top it will be 239 ft by 95 ft. I say that by way of introduction, because we are not talking about small-scale developments but about significant steel structures.
The context for what I will say next is that, at present, the structure dominates the skyline, and it is hoped that it will be floated out in April 1988. The problem is that in the run-up to Christmas people in this area of high unemployment look at the yard, see the structure and think that it may be the last fabrication order to be floated out, after a distinguished 10-year period.
That brings me to the crisis that grips the North sea offshore construction industry. The crisis is real and immediate and could lead next year to the collapse of one of the most efficient and productive areas of North sea-related activity. I will argue that the activities of the Department of Energy and of the Scottish Office have been characterised by neglect, complacency and a lack of interest, leading to the squandering of enormous potential for creating jobs and consolidating the long-term future of the offshore construction industry.
Let me start by revealing to the House that just two years ago, those seven construction yards employed nearly 12,000 people. We now find that after April 1988 when most of the current orders will be floated out, employment could be less than 1,000. By any standards, that is a dramatic reduction in manpower.
That is complemented, and, indeed, caused by a slump in investment. If we look at the investment in what we call top sides and jackets, we see that a total UK share of £1,077 million in 1984 slumpd to £480 million in 1986. Indeed, the UK Module Contractors Association Ltd. predicts that capacity utilisation for the industry could be less than 20 per cent. in 1988, with the prospect of those yards being unable to respond to the upturn in North sea activity that is expected in the early 1990s.
The overall picture is one of gloom and despondency, and great regret that such an industry, still in its infancy, has been ignored so much by the Government that we are talking about a terminal decline in construction capacity rather than looking forward to the next 20 or 30 years when billions of tonnes of oil will come out of the North sea.
More important, the impact will be devastating in three areas. The first is the jobs and skills of the men who produce such sophisticated structures. Secondly, local communities will be devastated. Those yards are mainly located in areas of high, significant and continuing unemployment. But probably more important for the future is the devastating impact on the strategic capacity of the offshore construction industry to deal with demand if an upturn in North sea activity is translated into orders.
If that is not bad enough, I am greatly concerned that the Government have been repeatedly warned about the impending crisis. The third report from the Select Committee on Energy, Session 1986–87, entitled, "The Effect of Oil and Gas Prices on Activity in the North Sea", was a major report which included representations from the United Kingdom Offshore Operators Association Ltd., the United Kingdom Module Contractors Association Ltd., major oil companies, such as British Petroleum and Shell, the Scottish Trades Union Congress, the Trades Union Congress and the Scottish Development Agency. They all had one compelling message, which was to highlight the development gap in the years 1986, 1987 and through to 1988. They also asked the Government to take action to avoid the crisis, which, sad to say, we are now experiencing.
The collapse in the oil price has merely worsened an already difficult situation. It would be both unreasonable and unfair for the Government to respond by saying that everything could be laid at the door of the market place and the resultant oil price collapse. Despite all that, the Government have been complacent and irresponsible in refusing to take any action that would stabilise the situation in the short term and help build medium and long-term prospects.
In blaming the Government, I should like to mention some factors. First, the Treasury has maximised royalties, petroleum revenue tax and corporation tax at the expense of any serious priority being given to long-term industrial development. Secondly, the Government have relied entirely on the price of oil to sustain development. When the oil price collapsed, the Government had nothing to fall back on. Thirdly, they have ignored advice on the strategic necessity of having an efficient construction industry with enough capacity to respond to changing demands.
Fourthly, the Government's obsession with free market economics has meant that we have no effective energy policy, unlike most of our competitors who see energy as an important resource to be used for long-term industrial development. We have used oil for short-term financial


expediency. Few countries, developed or undeveloped, have such contempt for natural resources and the potential that they offer for jobs and investment.
Fifthly, the Government have argued in the past that overcapacity in the offshore industry was the problem. That problem could reasonably be dealt with. We are now, however, moving towards no capacity, with skills, commitment and knowledge all being lost. That is a tragedy for the communities that I have mentioned and for the nation.
Sixthly, the men working in the yards, from the north of Scotland to the central belt, are frustrated, angry, and bitter, and deeply resent the way in which their jobs, communities and futures are being destroyed by a Government who, by surrendering to market forces, have betrayed the national interest. Despite claims by Ministers over the past few months about the anticipated increase in North sea activity in the medium term, prospects for the next 12 months are frighteningly bad. With the exception of a number of major developments, the only one that will be translated into an order is likely to be the Kittiwake field, operated by Shell. The Government have approved a number of others, but the development gap problem will mean no significant orders. That will facilitate the gradual rundown of the industry in the early part of the next year.
When the Government have allowed this crisis to develop, we shall hear that nothing can be done. They will talk of the market—the same old excuse for inactivity. Is it not possible, even at this eleventh hour, to decide on a reasonable notion of where the industry should be going in the next two or three years and in the run up to the year 2000?
I want to suggest some positive actions that the Government should take. First, we need a package of industrial and financial assistance that will allow existing yards to restructure their operations, with a planned approach to rationalising their capacity. We accept the need to rationalise overcapacity. That does not mean that we should kill the industry, as will happen if the present neglect continues. We also need Government assistance to diversification. Ministers speak long and eloquently about the need for the fabrication yards to diversify. They want to, but they need assistance. It cannot be done overnight. The Government can help.
Secondly, the Government need to carry out a construction audit of orders that are likely to emerge from the North sea over the next five years, to ensure that everything possible is done by the Department of Energy to avoid delays and minimise technical problems. The annex B procedure that is required for approvals could be speeded up without affecting safety, and I commend that suggestion to the Government. Thirdly, as we decline from peak production, we must also form an energy policy that will result in the planned development of oil and gas fields, to ensure the maintenance of a suitable size of construction industry in which abandonment programmes and technological modification schemes provide the maximum possible amount of work.
Fourthly, we need Government support to help to maintain an agreed size of industry. When the Government talk about Shell and BP, saying that they cannot do anything about this or that, I must remind them that the people of the United Kingdom did not elect Shell or BP. They elected the Government to intervene on their behalf when they feel, as they seem to now, that their interests are being neglected.
Fifthly, we need radical change in Government fiscal policy to encourage investment in Government-sponsored research and development to stimulate new field development. Minuscule progress was made on that in the Budget of March 1987. Much more could be done, and I suggest the Government examine the submissions of the UK Offshore Operators Association Limited and the Select Committee on Energy, which made some excellent proposals about the way forward in fiscal policy.
Sixthly, we must try to ensure that our construction yards are not exposed to unfair competition from European and Scandinavian yards when we bid for foreign orders. There is evidence—it is difficult to quantify—that that is happening already. Why do we have the fifth most productive oil field in the world, lying two or three miles off the Scottish coast, yet seven major fabrication construction yards without work? The public perception is that it is inconceivable that that could be a reality. The basis of my submission to the Minister is that that is indeed the reality facing Scotland and the yards in the next two or three months.
Surely it is not beyond the wit of a Government, even one committed ideologically to a free market, to say that we have a unique one-off oil and gas resource that will not last forever. A balance must be struck between exploitation of these reserves for jobs and industry, community welfare and prosperity and, on the other hand, the massive Exchequer funds gained as a result of the efforts that people in Scotland are making in the industry.
I wish to highlight the need for change and to identify how the offshore construction industry has shown realism and an ability to change to survive. With Government encouragement and support it is willing further to adapt in the years ahead. Over the past few years it has responded to the more difficult commercial conditions that have applied. It has improved its efficiency and has met the "weather windows" for the installation of North sea products. Higher standards of quality control are being achieved, and market forces are ensuring that lower prices are offered while quality is maintained.
In a submission to the Select Committee on Energy the United Kingdom Module Contractors Association Ltd., among many others, highlighted the continuing problems. Those include a lack of work, poor overhead recovery due to intermittent and low-volume work, difficult commercial conditions, and higher standards required by oil companies leading to higher costs for the fabricator.
The offshore industry can survive and adapt only if the Government provide the stability and financial support to see the industry through an extraordinarily difficult period. Workers, managers and customers require the Government to change course and to provide them with the right industrial and commercial environment in which they can all benefit. I am not making a special plea on behalf of one yard. I am making a special plea on behalf of the offshore construction industry. It needs support: if it is to maintain a presence in the six to 12 months that lie ahead. More important, we must ensure that in the year 2000 we have the industrial capacity in this very sophisticated business not only to deal with the North sea but to work from there and to have the export potential for which the Government are always arguing.

The Minister of State, Scottish Office (Mr. Ian Lang): I am glad of the opportunity afforded by the Adjournment


debate of the hon. Member for Fife, Central (Mr. McLeish) for the House to consider the prospects of the North sea offshore fabrication industry in Scotland. It is, of course, impossible to do so without looking at the oil industry generally, since the yards depend on continuing activity in exploration, development and production of the North sea oil and gas potential.
We are all conscious of the important role that the oil and oil-related industries play in the Scottish economy. I am pleased to note that all the signs are that they will continue to be major employers in the Scottish economy for a number of years. It is estimated that in mid-1987 over 50,000 people were employed in companies in Scotland wholly related to North sea oil and gas. That figure does not include people working in firms partly involved in supplying the North sea market or those engaged in short-term projects. When these extra jobs are taken into account, along with the effects on consumption, the overall level of oil-related employment in Scotland in mid-1987 is estimated to have been approximately 78,000, which is around 4 per cent of total employment in Scotland.
The majority of oil-related jobs are in the Grampian region, but many other regions also benefit. Throughout Scotland high levels of employment in certain sectors result directly from offshore activity. In Fife, approximately 1,600 jobs in wholly oil-related firms and 350 jobs in partly oil-related firms have been identified. While a proportion of these jobs are at the RGC yard at Methil, there are some other oil-related firms in the region.
With the downturn in oil prices, no one can pretend that the last 18 months have been other than tough for the oil industry and, therefore, for the fabrication yards. This resulting falling off in activity was of course, not limited to Scotland or to the North sea. It has to be recognised that the oil price collapse was a worldwide phenomenon largely influenced by OPEC's attempt to recover its major share of world oil supplies. As we know, this action brought the oil price tumbling from about $34 a barrel to under $10 a barrel. Therefore, it was not a localised problem that could readily be solved by simply seeking a market elsewhere.
The North sea industry was less quickly affected, and this contributed to such problems as a surplus of rigs in United Kingdom continental shelf waters, because some had been moved there from areas which had felt the effects of the fall more rapidly. There was an understandable tendency during that period for operators to retrench and to look for methods of economising in their undertakings. While production was not greatly affected, it is clear that development and exploration have slowed and that orders for new rigs have dropped.
My ministerial colleagues and I readily appreciate that in a period of slim prospects it is understandable that there should be calls for the Government to step in and somehow create work for the yards, but this is simply impractical as a solution to the immediate problem. The nature of the industry is such that there is inevitably a fairly lengthy lead-in period in the consideration of development before fabrication orders can be placed, as the hon. Member for Fife, Central will appreciate. In normal circumstances the oil companies are able to pace development to ensure a reasonably consistent flow of work. The suddenness and the extent of the oil price fall

created a hiatus which has to work through the system, and there is simply no practical way of short-circuiting this. Clearly, however, I would look to the oil companies to reduce this period in so far as they reasonably can.
I do not accept the argument that the current downturn in activity should materially alter the Government's general approach to North sea development. The Government's decision to leave the pace of development to the market has proved extremely beneficial to the Scottish economy and the offshore industry, and, in particular, to the fabrication yards. There were few complaints about the pace when development was at its peak and the demand for fabrication was high. While I understand the concern from which it stems, it is less than realistic to demand a new approach because we are now faced with a temporary lull in activity.
It is arguable that because until now we have experienced only the good times, the offshore industry did not anticipate, and has been so hard hit by, the present bad times. As I have said, for many in the North sea support industry this was the first experience of the cyclical nature of their undertaking. The tailing-off in demand came as a shock, and I would not attempt to minimise how traumatic this has been for those who have found themselves out of work as a result. Howard Doris at Loch Kishorn and Kestrel Marine at Dundee have gone into receivership, and I am well aware of the difficult situation in which a number of other yards find themselves at present.
Fortunately, most of the other yards have some work at present. For example, Hi-Fab has recently completed a rig conversion for Amerada Hess and is working on a jacket for Shell's Eider field. Lewis Offshore has also some Eider work, and McDermott's has an order for Shell's Tern field. In general, most yards have work of some description which will keep them employed until early or mid-1988. This is also the case with RGC at Methil, in which I appreciate the hon. Member for Fife, Central has a particular interest. As the hon Gentleman said, RGC has work on Shell's Tern platform and platform jacket. I can readily understand the concern of workers such as those at RGC who, although they have a yard which is equipped to handle a wide range of services for North sea clients, from jackets to modules and other offshore structures, have seen their work force gradually depleted from some 1,200 men to about half that number — with the prospect perhaps of even further cuts. It is a concern shared by some 4,000 workers in the fabrication sector of the industry.
Employment in the oil-related sector in Scotland was hardest hit during 1986. However, the underlying rate of decline in employment in wholly oil-related firms would appear to have slowed considerably this year. The 1·4 per cent. reduction in such employment in the six months to June 1987 was a considerable improvement on the 16·1 per cent. reduction over the previous six months. It would therefore seem likely that the worst effects of the oil price fall on employment have now been felt.
From my contacts with the oil industry I know that over the past few months there is increasing evidence of a pick-up in activity, with a general air of optimism that the greater stability in the oil price will continue. There are solid signs of this. Of course, of particular interest to the yards is the increased level of rig activity, which is now getting back to its pre-price drop level, and there is every sign of it continuing throughout next year.
After the depressing sight of rigs stacked in many of our firths it is encouraging to have 49 active rigs, against a low of 21 in February. This is all the more encouraging given that the going rate is some $17,000 a day compared with $14,000 in late 1986. Planned schedules indicate that drilling activity could be up soon by some 40 per cent., taking levels back to pre-1986, and there is every prospect of further rises over the next five years. Analysts forecast that by 1992 rates may have risen sufficiently to produce a demand for new rigs and the conversion of semi-submersibles into production vessels for some of the more marginal fields.
Despite the then depressed state of the market there was an encouraging response to the 10th round of offshore licensing, when 75 applications for 61 of the 127 blocks on offer led to 51 awards. I believe that my right hon. Friend the Secretary of State for Energy is currently considering the possibility of an 11th round, with awards in 1989, which would maintain the accustomed two-year licensing cycle. The Government have approved four major projects so far this year. In addition we have before us plans for the development of 11 offshore oil and gas projects, including six new oilfields, most of which should be approved within the next few weeks.
BP is pursuing the development of the Miller field, the largest and most significant North sea development for some years. This £900 million development, involving expected reserves of 300 million barrels of oil and 300 billion cu ft of gas, will create an estimated 6,000 offshore construction jobs prior to first production, which is estimated at the end of 1991. I need hardly say what this will mean to hungry yards, or point out that the competition for orders will be extremely fierce, but I would fully expect that those Scottish yards which gear themselves for survival during the lean early months of 1988, will show their capabilities to be leading contenders in this competition. The development plan for Miller is currently under consideration by the Department of Energy and I understand that signs are hopeful for a decision at the beginning of the year. There will, of course, be the added benefit of an estimated 400 jobs on a permanent basis when the field is in production.
Shell-Esso are also pressing on with their Kittiwake development, which gained approval in September. The construction of the Kittiwake platform and its equipment is estimated to provide a total of 2,500 jobs. The 7,000-tonne deck fabrication order is now out to tender. The order is expected to be placed early in 1988, with work starting in late summer. It will take two years to complete and employ up to 200 workers at its peak. The 6,000-tonne jacket order is due to be placed later in 1988, with work starting in 1989. This work should take about 15 months and at peak employ about 600.
There is also a range of proposals for gas-gathering in the central North sea, including possible further development at St. Fergus. I cannot anticipate what the outcome of these will be, and it is not certain that the successful transportation scheme itself will necessarily involve any major call for new structures. What is important, however, is that when in place it will make much more viable the development of these smaller fields for which a separate transportation system would have been uneconomical. The exploitation of these resources will clearly involve some structure fabrication, which will

inevitably improve the longer-term prospects for the yards. All these should have spin-off implications for the offshore supply industry and the fabrication yards.

Mr. McLeish: Will the Minister give way?

Mr. Lang: No, I would rather not. I am running rather short of time.
The hon. Gentleman will appreciate that I am not suggesting that these developments will mean a sudden return within the next few weeks to full employment at the fabrication yards. I wish only that they did. By the nature of the industry there will be an inevitable time lag before orders for new structures emerge. The market for such orders as do emerge will be highly competitive. The operators will of course be looking for the most cost-effective arrangements that they can get. This means that it is essential that if Scottish yards are to make the most of their opportunities they must be in a position to produce top quality work, based on the most modern techniques.
I recognise that some yards have invested heavily in preparing themselves for the new market conditions. Indeed, it is one of the long-term gains of this lean time that the industry has been obliged to react by seeking new cost-cutting technology and adopting new practices and innovative procedures. Many of these changes represent valuable assets which can be exploited in other aspects of industry both in the United Kingdom and elsewhere to the great benefit of the economy.
Good examples of such modernisation can be seen in yards such as McDermott's, where a three-year investment programme of some £22 million has provided a stockyard gantry crane for handling plate, an advanced plate-cutting facility, a pipe-mill and spool fabrication facility and a computer-controlled warehouse with automatic storage and retrieval facility.
I realise how difficult it is for some yards to gear themselves in this way when they are striving to stay in existence with a very uncertain order book beyond early 1988. The next few months will be critical for them. There are no immediate short-term solutions to this. The hard fact is, as I have said, that the Government cannot conjure up work for the fabrication yards. That must continue to lie with the operators.
What the Government can do, and have done, is to ensure that the right fiscal climate exists in which operators can continue to develop the North sea's resources. In autumn 1986 we took action on the early repayment of advance petroleum revenue tax, which was expected to inject more than £300 million into the oil economy. In the 1987 Budget my right hon. Friend the Chancellor of the Exchequer proposed two further concessions affecting the development of new fields and oil-related research, which were expected to benefit the industry by over £100 million a year. Much of this is aimed generally at encouraging companies to proceed with projects which would otherwise have been delayed, and this is clearly having the desired effect. In particular, it is encouraging that the industry is increasingly looking at how to extract oil and gas economically from what had previously been looked upon as marginal fields.
The Government will continue to play their role by ensuring that a propr fiscal climate is maintained, and we expect to see a gradual improvement in the fortunes of the fabrication yards as activity in North sea developments increases. I know that the oil companies appreciate that


the continuing existence of a variety of modern highly competitive yards is not only important but vital to the cost-effective development of the industry's interests generally.
Question put and agreed to.
Adjourned accordingly at half-past Twelve o'clock.